{ "hospital_name": "Central Maine Medical Center", "last_updated_on": "2026-04-29", "version": "3.0", "location_name": [ "Central Maine Medical Center" ], "hospital_address": [ "300 Main Street, Lewiston, ME 04240" ], "license_information": { "license_number": "40000", "state": "ME" }, "attestation": { "attestation": "To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.", "confirm_attestation": true, "attester_name": "Allen Stefanek" }, "type_2_npi": [ "1689653487", "1073651576" ], "standard_charge_information": [ { "description": "Insulin Regular (Human) Inj 100 Unit/ML - 00002821501 - 25000001", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "00002821501", "type": "NDC" }, { "code": "J1815", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "Levofloxacin in D5W IV Soln 750 MG/150ML", "drug_information": { "unit": 150.0, "type": "ML" }, "code_information": [ { "code": "00409444401", "type": "NDC" }, { "code": "J1956", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2.2145, "maximum": 2.2145, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2.21 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 21.73, "10th_percentile": 21.73, "90th_percentile": 21.73, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL L0150) CERV SEMI-RIG ADJ MOLDED CHN", "code_information": [ { "code": "L0150", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 141.0, "minimum": 137.6749, "maximum": 239.5923, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 141.67, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 172.09, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 137.67, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 141.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 141.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 154.42, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 141.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 141.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 239.59, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL C9358) SURGIMEND, FETAL", "code_information": [ { "code": "C9358", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 43.4515, "maximum": 43.4515, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 43.45 } ] } ] }, { "description": "HC (SUP SHELL C9362) IMPLNT,BON VOID FILLER-STRIP", "code_information": [ { "code": "C9362", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 225.0835, "maximum": 225.0835, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 225.08 } ] } ] }, { "description": "HC R&L HEART CATH INJ VETRICULOGRAPHY, RS/I", "code_information": [ { "code": "93453", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16181.9, "discounted_cash": 3198.0, "minimum": 3198.82, "maximum": 15308.5929, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12602.07, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15308.59, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12247.32, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3486.71, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5409.84, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC IGG 1 2 3 OR 4 EACH", "code_information": [ { "code": "82787", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 82.5, "discounted_cash": 8.0, "minimum": 7.7938, "maximum": 71.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 143.4, "10th_percentile": 143.4, "90th_percentile": 143.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.02, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.74, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7.79, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 181.0, "10th_percentile": 181.0, "90th_percentile": 296.66, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 42.08 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.74, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.56, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC THROAT SURGERY PROCEDURE", "code_information": [ { "code": "42999", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1160.94, "discounted_cash": 233.0, "minimum": 233.7, "maximum": 1118.4181, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 920.68, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1118.42, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 894.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 254.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 395.23, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF ESTRIOL", "code_information": [ { "code": "82677", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 359.38, "discounted_cash": 24.0, "minimum": 23.4981, "maximum": 313.3794, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 29.37, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 126.88 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.36, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.89, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF TOPIRAMATE", "code_information": [ { "code": "80201", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 210.31, "discounted_cash": 11.0, "minimum": 11.5839, "maximum": 183.3903, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.58, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 62.55 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.99, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.16, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Chloroprocaine HCl Preservative Free (PF) Inj 3%", "drug_information": { "unit": 20.0, "type": "ML" }, "code_information": [ { "code": "63323047801", "type": "NDC" }, { "code": "J2401", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC (SUP SHELL Q4121) THERASKIN", "code_information": [ { "code": "Q4121", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 111.3485, "maximum": 605.4868, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 111.35 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Enoxaparin Sodium Inj Soln Pref Syr 80 MG/0.8ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00075062201", "type": "NDC" }, { "code": "J1650", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.118, "maximum": 1.118, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 35.37, "10th_percentile": 35.37, "90th_percentile": 35.37, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.12 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 41.68, "10th_percentile": 41.68, "90th_percentile": 43.54, "count": "1 through 10" } ] } ] }, { "description": "VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC", "code_information": [ { "code": "805", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9255.0, "minimum": 6907.49, "maximum": 19500.9713, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 11327.68, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 12524.12, "10th_percentile": 12524.12, "90th_percentile": 12524.12, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8923.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 19500.97 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8923.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 11005.89, "standard_charge_algorithm": "76.27% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 11511.62, "10th_percentile": 11511.62, "90th_percentile": 11511.62, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8923.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 11317.95 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9255.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6907.49 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9255.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11318.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8923.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 9255.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8923.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12002.52 } ] } ] }, { "description": "INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC", "code_information": [ { "code": "854", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16244.0, "minimum": 13829.51, "maximum": 54222.2694, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 48812.48, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 57996.71, "10th_percentile": 57996.71, "90th_percentile": 57996.71, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15629.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 36105.35 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 15629.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "other", "standard_charge_dollar": 46138.67, "standard_charge_algorithm": "74.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 35793.77, "10th_percentile": 35793.77, "90th_percentile": 35793.77, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 15629.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 30364.98 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 16244.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13829.51 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16244.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 30365.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15629.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 16244.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15629.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22222.23 } ] } ] }, { "description": "HC BCR/ABL1 GENE MINOR BP", "code_information": [ { "code": "81207", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1550.31, "discounted_cash": 144.0, "minimum": 140.7555, "maximum": 1351.8703, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 144.84, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 175.94, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 140.76, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 760.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 144.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 144.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 157.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 144.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 144.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 244.95, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Butorphanol Tartrate Inj 2 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00409162621", "type": "NDC" }, { "code": "J0595", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 10.0835, "maximum": 10.0835, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.08 } ] } ] }, { "description": "HC (SUP SHELL A6207) CONTACT LAYER >16<= 48 SQ IN", "code_information": [ { "code": "A6207", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 10.0, "minimum": 10.1747, "maximum": 17.7069, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10.47, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.72, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 10.17, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 10.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 10.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.41, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 10.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELLQ4237) CRYO-CORD, PER SQ CM", "code_information": [ { "code": "Q4237", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 126.52, "maximum": 912.6105, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 912.61 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITHOUT CCMCC", "code_information": [ { "code": "756", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8353.0, "minimum": 6609.87, "maximum": 20773.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8057.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 17356.08 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8057.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8057.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 20773.27 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8353.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6609.87 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8353.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20773.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8057.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8353.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8057.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10682.37 } ] } ] }, { "description": "HC EVAL C/V AMNIOTIC FLUD PROTEIN QUAL EA SPECIMEN", "code_information": [ { "code": "84112", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 242.81, "discounted_cash": 98.0, "minimum": 72.843, "maximum": 242.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 130.54, "10th_percentile": 130.54, "90th_percentile": 130.54, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 98.11, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 119.17, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 95.34, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 242.81 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 98.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 194.25, "10th_percentile": 194.25, "90th_percentile": 194.25, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 98.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 106.94, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 98.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 169.39, "10th_percentile": 169.39, "90th_percentile": 341.88, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 98.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 165.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ELECTROLYTE PANEL", "code_information": [ { "code": "80051", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 118.13, "discounted_cash": 7.0, "minimum": 6.8123, "maximum": 103.0094, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6.81, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 63.57, "10th_percentile": 63.57, "90th_percentile": 63.57, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.78 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 31.33, "10th_percentile": 31.33, "90th_percentile": 31.33, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 78.54, "10th_percentile": 78.54, "90th_percentile": 78.54, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.86, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 89.25, "10th_percentile": 89.25, "90th_percentile": 89.25, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.52, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MASTECTOMY FOR MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "583", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14162.0, "minimum": 11369.67, "maximum": 56858.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13632.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 31159.63 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13632.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13632.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 56858.6 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14162.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11369.67 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14162.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 56858.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13632.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 14162.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13632.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19178.22 } ] } ] }, { "description": "HC OPEN/PERQ PLACEMENT INTRAVASCULAR STNT SAME 1ST", "code_information": [ { "code": "37238", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 39143.8, "discounted_cash": 11390.0, "minimum": 11390.68, "maximum": 39143.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 39143.8, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 39143.8, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 39143.8, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12415.84, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19263.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF AMMONIA", "code_information": [ { "code": "82140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 305.94, "discounted_cash": 14.0, "minimum": 14.1591, "maximum": 266.7797, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 328.94, "10th_percentile": 328.94, "90th_percentile": 328.94, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.7, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.16, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 164.64, "10th_percentile": 164.64, "90th_percentile": 167.8, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 76.45 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.64, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT HUMERAL SUPRACONDYLAR FX WO MANIP", "code_information": [ { "code": "24530", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 878.75, "discounted_cash": 243.0, "minimum": 243.38, "maximum": 878.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 411.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "VAGINAL DELIVERY WITH STERILIZATION ANDOR D&C WITH MCC", "code_information": [ { "code": "796", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9923.0, "minimum": 7343.53, "maximum": 25238.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9564.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 21087.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9564.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9564.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 25238.88 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9923.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7343.53 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9923.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25238.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9564.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 9923.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9564.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12979.0 } ] } ] }, { "description": "HC MUSCULOSKELETAL NUCLEAR EXAM", "code_information": [ { "code": "78399", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1413.44, "discounted_cash": 394.0, "minimum": 394.45, "maximum": 1413.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1413.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1413.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1413.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT HEEL FX W MANIP", "code_information": [ { "code": "28405", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 404.06, "discounted_cash": 243.0, "minimum": 121.218, "maximum": 404.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "WOUND DEBRIDEMENTS FOR INJURIES WITH CC", "code_information": [ { "code": "902", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15608.0, "minimum": 13133.92, "maximum": 40393.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15019.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 34594.71 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 15019.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 15019.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 40393.12 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 15608.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13133.92 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15608.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 40393.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15019.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 15608.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15019.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21292.46 } ] } ] }, { "description": "HC (SUP SHELL A4353) INTERMITTENT URINARY CATH", "code_information": [ { "code": "A4353", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 9.0, "minimum": 9.6888, "maximum": 16.8613, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.97, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9.69, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 9.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 9.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.87, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 9.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.86, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC", "code_information": [ { "code": "559", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15231.0, "minimum": 12848.06, "maximum": 57764.4749, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 52001.28, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 15945.18, "10th_percentile": 15945.18, "90th_percentile": 15945.18, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14657.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 33698.44 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14657.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14657.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 32969.93 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 15231.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12848.06 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15231.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32969.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14657.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 15231.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14657.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20740.82 } ] } ] }, { "description": "HC REPR WND INTRMD FACE 7.6-12.5 CM", "code_information": [ { "code": "12054", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 698.44, "discounted_cash": 401.0, "minimum": 209.532, "maximum": 698.44, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 437.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 678.34, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A7507) INTEGRATED FILTER & HOLDER", "code_information": [ { "code": "A7507", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 3.0, "minimum": 3.4596, "maximum": 6.0207, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.56, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.32, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3.46, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.02, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC QUANTITATIVE SCREEN, METALS", "code_information": [ { "code": "83018", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 100.94, "discounted_cash": 21.0, "minimum": 21.3407, "maximum": 100.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 21.96, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 26.67, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 21.34, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 100.94 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 21.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 21.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.94, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 21.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4629) TRACHEOSTOMY CARE KIT - A4629 - RU272069", "code_information": [ { "code": "A4629", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 6.0, "minimum": 6.443, "maximum": 11.2127, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6.44, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.23, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER O.R. PROCEDURES FOR INJURIES WITH CC", "code_information": [ { "code": "908", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16222.0, "minimum": 13961.01, "maximum": 86590.8208, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15608.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 36052.94 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 15608.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 75975.5, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 194291.5, "10th_percentile": 194291.5, "90th_percentile": 194291.5, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 15608.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 33347.9 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 16222.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13961.01 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16222.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 33347.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 86590.82, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 86474.26, "10th_percentile": 86474.26, "90th_percentile": 86474.26, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15608.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 16222.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15608.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22189.98 } ] } ] }, { "description": "HC UNLISTED PROCEDURE LIPS", "code_information": [ { "code": "40799", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1227.5, "discounted_cash": 233.0, "minimum": 233.7, "maximum": 1118.4181, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 920.68, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1118.42, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 894.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 254.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 395.23, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PROLONGED IV INF, REQ PUMP - C8957 - 26100001 - 26100001", "code_information": [ { "code": "C8957", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1091.25, "discounted_cash": 209.0, "minimum": 209.87, "maximum": 1004.3749, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 826.8, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1004.37, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 803.53, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 228.76, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 354.93, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4373) SKIN BARRIER WITH FLANGE", "code_information": [ { "code": "A4373", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 8.0, "minimum": 8.6879, "maximum": 15.1193, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.94, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.86, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8.69, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.74, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.12, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INJECTION; SPIDER VEINS,LIMB/TRUNK", "code_information": [ { "code": "36468", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 598.44, "discounted_cash": 401.0, "minimum": 179.532, "maximum": 598.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 598.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 598.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 598.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 437.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 598.44, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE", "code_information": [ { "code": "10030", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 790.0, "discounted_cash": 698.0, "minimum": 237.0, "maximum": 790.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 790.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 790.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 790.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 761.59, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 790.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC SERUM SCREENING % REACTIVE ANTIBODY STANDRD METH", "code_information": [ { "code": "86807", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 578.75, "discounted_cash": 78.0, "minimum": 76.4321, "maximum": 504.67, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 78.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 133.01, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 78.65, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 95.54, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 76.43, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 412.69 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 78.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 78.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 85.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 78.65, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC VEEG BY TECH 2-12 HR CONTINUOUS R-T MONITORNG", "code_information": [ { "code": "95713", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2078.75, "discounted_cash": 368.0, "minimum": 368.19, "maximum": 1812.67, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1450.52, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1762.05, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1409.69, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 401.33, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 622.68, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "NEONATE WITH OTHER SIGNIFICANT PROBLEMS", "code_information": [ { "code": "794", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12272.0, "minimum": 4437.1699, "maximum": 60283.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 5936.9, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 4045.18, "10th_percentile": 1059.76, "90th_percentile": 19615.76, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11818.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 26669.28 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11818.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 5768.25, "standard_charge_algorithm": "76.27% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 7127.62, "10th_percentile": 7127.62, "90th_percentile": 7127.62, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 5786.4, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 5642.72, "10th_percentile": 2781.86, "90th_percentile": 13236.93, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11818.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 60283.79 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "other", "standard_charge_dollar": 6579.75, "standard_charge_algorithm": "87% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 5346.4, "10th_percentile": 5346.4, "90th_percentile": 5346.4, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12272.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10217.27 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12272.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 60283.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 6594.87, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 4115.56, "10th_percentile": 1472.42, "90th_percentile": 12277.86, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11818.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 12272.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11818.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16414.49 } ] } ] }, { "description": "HC PRQ DRUG ELUTING COR REVASC W AMI S - 92941 - 48100198", "code_information": [ { "code": "92941", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 27935.9, "minimum": 8380.77, "maximum": 27935.9, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 27935.9 } ] } ] }, { "description": "Cefazolin Sodium-Dextrose IV Solution 2 GM/100ML-4%", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "00338350841", "type": "NDC" }, { "code": "J0690", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.7845, "maximum": 1.7845, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 25.87, "10th_percentile": 11.99, "90th_percentile": 26.05, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.78 } ] } ] }, { "description": "HC MR SAFETY MED PHYSICS XM CUSTOMIZATION PLNG&MNTR", "code_information": [ { "code": "76017", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 906.56, "discounted_cash": 235.0, "minimum": 235.42, "maximum": 906.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 906.56, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 906.56, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 901.35, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 256.61, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC AMPUTATION TOE INTERPHALANGEAL JOINT", "code_information": [ { "code": "28825", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7192.19, "discounted_cash": 3228.0, "minimum": 2157.657, "maximum": 7192.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7192.19, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7192.19, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7192.19, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3519.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5460.01, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A5054) CLSD OSTOMY POUCH W/FLANGE", "code_information": [ { "code": "A5054", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 2.0, "minimum": 2.4878, "maximum": 4.3295, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2.56, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.11, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2.49, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.79, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.33, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4265) PARAFFIN", "code_information": [ { "code": "A4265", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 4.0, "minimum": 4.7229, "maximum": 8.2192, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.9, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.72, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC SEMEN ANALYSIS STRICT MORPHOLOGIC CRITERIA", "code_information": [ { "code": "89322", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 384.06, "discounted_cash": 15.0, "minimum": 15.0629, "maximum": 334.9003, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 194.71, "10th_percentile": 194.71, "90th_percentile": 194.71, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.83, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 15.06, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 81.33 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.9, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Mepivacaine HCl Preservative Free (PF) Inj 2%", "drug_information": { "unit": 20.0, "type": "ML" }, "code_information": [ { "code": "63323029401", "type": "NDC" }, { "code": "J0670", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 7.8045, "maximum": 7.8045, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.8 } ] } ] }, { "description": "RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CCMCC", "code_information": [ { "code": "179", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6790.0, "minimum": 5327.35, "maximum": 22014.5444, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6557.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 13642.73 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6557.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6557.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 11814.77 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6790.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5327.35 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6790.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11814.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6557.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 6790.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6557.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8396.87 } ] } ] }, { "description": "HC SMEAR COMPLEX STAIN", "code_information": [ { "code": "87209", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 168.75, "discounted_cash": 17.0, "minimum": 17.473, "maximum": 147.15, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 101.8, "10th_percentile": 101.8, "90th_percentile": 101.8, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.84, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 17.47, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 81.06, "10th_percentile": 81.06, "90th_percentile": 81.06, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 87.24, "10th_percentile": 87.24, "90th_percentile": 90.81, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 94.34 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 80.37, "10th_percentile": 80.37, "90th_percentile": 80.37, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 111.98, "10th_percentile": 94.04, "90th_percentile": 265.28, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.41, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CCMCC", "code_information": [ { "code": "419", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11435.0, "minimum": 9119.54, "maximum": 37215.3328, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11015.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 24679.79 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11015.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 32550.61, "standard_charge_algorithm": "76.27% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 30565.32, "10th_percentile": 30565.32, "90th_percentile": 30565.32, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11015.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 31089.76 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 11435.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9119.54 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11435.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 31089.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11015.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 11435.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11015.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15189.99 } ] } ] }, { "description": "HC CLSD TREAT ELBOW DISLOC W ANES", "code_information": [ { "code": "24605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2052.81, "discounted_cash": 1586.0, "minimum": 615.843, "maximum": 2052.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2052.81, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2052.81, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2052.81, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1729.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2052.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC OPEN TREAT DIST PHALANGEAL FX EA", "code_information": [ { "code": "26765", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4149.69, "discounted_cash": 3228.0, "minimum": 1244.907, "maximum": 4149.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4149.69, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4149.69, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4149.69, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3519.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4149.69, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MRI BREAST WITHOUT CONTRAST MATERIAL BILATERAL", "code_information": [ { "code": "77047", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1235.31, "discounted_cash": 235.0, "minimum": 235.42, "maximum": 1235.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 927.46, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1126.65, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 901.35, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1235.31 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 256.61, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CCMCC", "code_information": [ { "code": "241", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11576.0, "minimum": 10450.52, "maximum": 29940.24, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11151.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 25015.89 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11151.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11151.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 29940.24 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 11576.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10450.52 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11576.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 29940.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11151.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 11576.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11151.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15396.85 } ] } ] }, { "description": "HC ERCP,BIOPSY", "code_information": [ { "code": "43261", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6436.56, "discounted_cash": 3804.0, "minimum": 1930.968, "maximum": 6436.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6436.56, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6436.56, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6436.56, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4146.58, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6433.66, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PULMONARY STRESS TESTING, COMPLEX", "code_information": [ { "code": "94621", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 982.19, "discounted_cash": 368.0, "minimum": 294.657, "maximum": 982.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 982.19, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 982.19, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 982.19, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 401.33, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 622.68, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC NASOPHARYNGOSCOPY WITH ENDOSCOPE", "code_information": [ { "code": "92511", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 248.13, "discounted_cash": 196.0, "minimum": 74.439, "maximum": 248.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 248.13, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 248.13, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 248.13, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 214.68, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 248.13, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTITIS MEDIA AND URI WITHOUT MCC", "code_information": [ { "code": "153", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6662.0, "minimum": 4925.91, "maximum": 13339.1559, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 9564.18, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 8139.57, "10th_percentile": 8139.57, "90th_percentile": 8139.57, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6435.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 13339.16 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6435.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6435.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 8455.82 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6662.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4925.91 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6662.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8455.82 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6435.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 6662.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6435.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8210.02 } ] } ] }, { "description": "ALLOGENEIC BONE MARROW TRANSPLANT", "code_information": [ { "code": "014", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 92448.0, "minimum": 88751.4, "maximum": 236027.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 88751.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 217161.53 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 88751.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 88751.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 236026.61 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 92448.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 90681.88 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 92448.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 236027.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 88751.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 92448.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 88751.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 133659.24 } ] } ] }, { "description": "WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "465", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14918.0, "minimum": 12016.12, "maximum": 43845.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14356.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 32953.97 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14356.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14356.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 43845.6 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14918.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12016.12 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14918.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 43845.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 31785.66, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 31645.6, "10th_percentile": 31645.6, "90th_percentile": 31645.6, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14356.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 14918.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14356.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20282.61 } ] } ] }, { "description": "INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CCMCC", "code_information": [ { "code": "022", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 25213.0, "minimum": 19116.71, "maximum": 68716.24, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24235.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 25213.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 24235.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 35338.03 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24235.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 57415.11 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 24235.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24235.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 68716.24 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 25213.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19116.71 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 25213.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 68716.2 } ] } ] }, { "description": "HC TX INCOMPLETE ABORTION ANY TRIMESTER SURGICAL", "code_information": [ { "code": "59812", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2415.63, "discounted_cash": 3194.0, "minimum": 724.689, "maximum": 2415.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 6073.7, "10th_percentile": 6073.7, "90th_percentile": 6073.7, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2415.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2415.63, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2415.63, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2415.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2415.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2415.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2415.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2415.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2415.63, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2415.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2415.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2415.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2415.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2415.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2415.63, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DRAIN BLOOD FROM UNDER NAIL", "code_information": [ { "code": "11740", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 205.0, "discounted_cash": 131.0, "minimum": 61.5, "maximum": 205.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 205.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 205.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 205.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.08, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 205.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL C1896) LEAD AICD NON SING/DUAL", "code_information": [ { "code": "C1896", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 13911.97, "10th_percentile": 13911.97, "90th_percentile": 13911.97, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL A6243) HYDROGEL DRG >16<=48 W/O BDR", "code_information": [ { "code": "A6243", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 17.0, "minimum": 17.0648, "maximum": 29.6975, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.56, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.33, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 17.06, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 17.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 17.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.14, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 17.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CMV ANTIBODY", "code_information": [ { "code": "86644", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 226.25, "discounted_cash": 14.0, "minimum": 13.9842, "maximum": 197.29, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 114.0, "10th_percentile": 114.0, "90th_percentile": 114.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.48, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13.98, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 75.51 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.69, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 125.4, "10th_percentile": 125.4, "90th_percentile": 125.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "853", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 38607.0, "minimum": 34615.65, "maximum": 122246.2931, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 37088.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 89239.71 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 37088.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 37088.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 84199.74 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 38607.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34615.65 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 38607.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 84199.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 37088.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 38607.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 37088.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 54925.53 } ] } ] }, { "description": "HC (SUP SHELL A4614) HAND-HELD PEFR METER", "code_information": [ { "code": "A4614", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 33.0, "minimum": 32.9343, "maximum": 57.3148, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 33.89, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 41.17, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 32.93, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 33.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 33.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.94, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 33.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 33.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 57.31, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Diphenhydramine HCl Tab 50 MG", "drug_information": { "unit": 100.0, "type": "EA" }, "code_information": [ { "code": "70000061601", "type": "NDC" }, { "code": "Q0163", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC (SUP SHELL A6446) CONFORM BAND S W>=3 <5/YD - A6446 - RU272064", "code_information": [ { "code": "A6446", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF CALCIUM, IONIZED", "code_information": [ { "code": "82330", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 235.94, "discounted_cash": 13.0, "minimum": 13.2942, "maximum": 205.7397, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 151.0, "10th_percentile": 151.0, "90th_percentile": 151.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.62, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13.29, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 129.41, "10th_percentile": 129.41, "90th_percentile": 129.41, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 71.78 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 164.59, "10th_percentile": 164.59, "90th_percentile": 164.59, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC", "code_information": [ { "code": "433", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9080.0, "minimum": 7404.44, "maximum": 23486.3249, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8755.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 19085.37 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8755.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 20542.45, "standard_charge_algorithm": "76.27% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 16084.56, "10th_percentile": 16084.56, "90th_percentile": 16084.56, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8755.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 17480.56 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9080.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7404.44 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9080.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17480.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8755.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 9080.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8755.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11746.72 } ] } ] }, { "description": "KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC", "code_information": [ { "code": "486", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16951.0, "minimum": 14679.45, "maximum": 43216.0787, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16308.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 37785.84 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 16308.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 16308.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 36056.11 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 16951.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14679.45 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16951.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 36056.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16308.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 16951.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16308.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23256.55 } ] } ] }, { "description": "HC (SUP SHELL A6223) GAUZE >16<=48 NO W/SAL W/O B - A6223 - 27200127", "code_information": [ { "code": "A6223", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 3.0, "minimum": 3.3624, "maximum": 5.8516, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3.36, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.77, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.85, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.46, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.2, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.46, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Digoxin Inj 0.25 MG/ML", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "00781305972", "type": "NDC" }, { "code": "J1160", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 10.492, "maximum": 10.492, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.49 } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC", "code_information": [ { "code": "617", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15272.0, "minimum": 13369.24, "maximum": 57018.5336, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14697.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 33796.02 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14697.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14697.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 30236.39 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 15272.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13369.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15272.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 30236.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14697.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 15272.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14697.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20800.88 } ] } ] }, { "description": "HC (SUP SHELL C1760) CLOSURE DEVICE VASCULAR", "code_information": [ { "code": "C1760", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 773.68, "10th_percentile": 773.68, "90th_percentile": 773.68, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL Q4186) EPIFIX PER SQ CM", "code_information": [ { "code": "Q4186", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 126.52, "maximum": 605.4868, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 340.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CALR GENE ANALYSIS COMMON VARIANTS IN EXON 9", "code_information": [ { "code": "81219", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1601.56, "discounted_cash": 121.0, "minimum": 118.2, "maximum": 1396.5603, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 121.63, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 147.74, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 118.2, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 638.22 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 121.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 121.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 132.58, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 121.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 121.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 205.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL Q4138) BIODFENCE DRYFLEX, 1CM", "code_information": [ { "code": "Q4138", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 126.52, "maximum": 605.4868, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 202.66 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Clindamycin Phosphate in D5W IV Soln 900 MG/50ML", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "00338381450", "type": "NDC" }, { "code": "J0736", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 3.4615, "maximum": 3.4615, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.46 } ] } ] }, { "description": "Epoetin Alfa Inj 20000 Unit/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "55513047801", "type": "NDC" }, { "code": "J0885", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 7.0, "minimum": 7.305, "maximum": 28.7788, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 28.78, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.37, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8.3, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.22 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.96, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.35, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4557) LEAD WIRES, PAIR", "code_information": [ { "code": "A4557", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 13.0, "minimum": 12.7403, "maximum": 22.1716, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.11, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.74, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 13.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC IMAG,ACUTE VENOUS THRMBSIS,UNILAT", "code_information": [ { "code": "78457", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1004.38, "discounted_cash": 535.0, "minimum": 301.314, "maximum": 1004.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1004.38, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1004.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1004.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1004.38 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 583.96, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 906.04, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Amino Acid Infusion 4.25% in D5W", "drug_information": { "unit": 2000.0, "type": "ML" }, "code_information": [ { "code": "00338108904", "type": "NDC" }, { "code": "J7070", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 7.826, "maximum": 7.826, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.83 } ] } ] }, { "description": "Azithromycin For Susp 200 MG/5ML", "drug_information": { "unit": 23.0, "type": "ML" }, "code_information": [ { "code": "42806015033", "type": "NDC" }, { "code": "Q0144", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 54.1585, "maximum": 54.1585, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 54.16 } ] } ] }, { "description": "HC EXCHANGE NEPHROSTOMY CATH, PERQ", "code_information": [ { "code": "50435", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3556.25, "discounted_cash": 2062.0, "minimum": 1066.875, "maximum": 3556.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3556.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3556.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3556.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 2077.1, "10th_percentile": 2077.1, "90th_percentile": 2077.1, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2248.21, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 2480.84, "10th_percentile": 2480.84, "90th_percentile": 2480.84, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3488.24, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CHEST X-RAY 2 VW", "code_information": [ { "code": "71046", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 319.06, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 319.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 204.2, "10th_percentile": 171.53, "90th_percentile": 204.2, "count": "37" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 319.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 319.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 319.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 922.15, "10th_percentile": 922.15, "90th_percentile": 922.15, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 204.73 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 92.04, "10th_percentile": 92.04, "90th_percentile": 171.53, "count": "21" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 222.58, "10th_percentile": 201.03, "90th_percentile": 224.62, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "REVISION OF HIP OR KNEE REPLACEMENT WITH CC", "code_information": [ { "code": "467", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 27869.0, "minimum": 23706.94, "maximum": 125395.9357, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 26784.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 26784.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 75178.91 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 27869.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23706.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 27869.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 75178.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 26784.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 27869.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 26784.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 39221.72 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 26784.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 63725.1 } ] } ] }, { "description": "CERVICAL SPINAL FUSION WITH CC", "code_information": [ { "code": "472", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23454.0, "minimum": 20052.48, "maximum": 59105.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 22547.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 53235.56 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 22547.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 22547.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 59105.05 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 23454.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20052.48 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23454.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 59105.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 22547.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 23454.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 22547.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 32765.58 } ] } ] }, { "description": "HC ASSAY VIT D, 1,25-DIHYDROXY W FRACTIONS", "code_information": [ { "code": "82652", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 448.44, "discounted_cash": 38.0, "minimum": 37.4143, "maximum": 391.0397, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 172.1, "10th_percentile": 172.1, "90th_percentile": 172.1, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 46.77, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 37.41, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 241.33, "10th_percentile": 241.33, "90th_percentile": 245.96, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 202.02 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.97, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 312.83, "10th_percentile": 201.36, "90th_percentile": 315.7, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 65.11, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "581", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12023.0, "minimum": 9961.18, "maximum": 47144.14, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11579.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 26076.59 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11579.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11579.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 47144.14 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12023.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9961.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12023.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 47144.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11579.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 12023.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11579.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16049.7 } ] } ] }, { "description": "HC (SUP SHELL A6199) ALGINATE DRSG WOUND FILLER", "code_information": [ { "code": "A6199", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 7.0, "minimum": 7.3079, "maximum": 12.7178, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.13, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.72, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PLACEMENT XTN PROSTH FOR ENDOVASCULAR RPR", "code_information": [ { "code": "34709", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6033.13, "minimum": 1809.939, "maximum": 6033.13, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 6033.13 } ] } ] }, { "description": "HC (SUP SHELL A5071) URINARY POUCH W/BARRIER", "code_information": [ { "code": "A5071", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 8.0, "minimum": 8.3283, "maximum": 14.4936, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.57, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.41, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8.33, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.49, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REMOVAL TUNLD CV CATH W SUBQ PORT/PUMP", "code_information": [ { "code": "36590", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5641.88, "discounted_cash": 1553.0, "minimum": 1553.22, "maximum": 5641.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5641.88, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5641.88, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5641.88, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.3, "median_amount": 3620.37, "10th_percentile": 3620.37, "90th_percentile": 3620.37, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 3499.08, "10th_percentile": 3499.08, "90th_percentile": 3499.08, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 1809.22, "10th_percentile": 1809.22, "90th_percentile": 1809.22, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1693.01, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 3450.47, "10th_percentile": 3450.47, "90th_percentile": 3450.47, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2626.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF G6PD ENZYME", "code_information": [ { "code": "82955", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 80.63, "discounted_cash": 9.0, "minimum": 9.4265, "maximum": 70.3094, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.78, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9.43, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 41.09, "10th_percentile": 41.09, "90th_percentile": 41.09, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 44.22, "10th_percentile": 44.22, "90th_percentile": 44.22, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50.9 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.57, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 56.24, "10th_percentile": 50.9, "90th_percentile": 56.76, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.4, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC", "code_information": [ { "code": "660", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11100.0, "minimum": 9274.58, "maximum": 31157.4768, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 28048.88, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 21796.14, "10th_percentile": 21796.14, "90th_percentile": 21796.14, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10693.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 23882.91 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10693.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10693.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 23931.54 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 11100.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9274.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11100.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23931.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10693.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 11100.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10693.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14699.52 } ] } ] }, { "description": "HC INTRO CATH DIALYSIS CIRC DX ANGRPH FLUOR S&I", "code_information": [ { "code": "36901", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3139.69, "discounted_cash": 1553.0, "minimum": 941.907, "maximum": 3139.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3139.69, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3139.69, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3139.69, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 3009.48, "10th_percentile": 3009.48, "90th_percentile": 3159.93, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1693.01, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2626.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC TCAT INS/RPL PERM LDLS PM W/IG", "code_information": [ { "code": "33274", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 88901.3, "discounted_cash": 19005.0, "minimum": 19005.55, "maximum": 88901.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 74874.26, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 88901.3, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 72766.55, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20716.05, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32142.19, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "358", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11679.0, "minimum": 9379.09, "maximum": 27820.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11249.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 25259.83 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11249.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11249.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 27820.44 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 11679.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9379.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11679.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 27820.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11249.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 11679.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11249.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15547.0 } ] } ] }, { "description": "PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITH MCC", "code_information": [ { "code": "250", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17646.0, "minimum": 16006.27, "maximum": 72452.5616, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16975.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 39437.43 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 16975.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 16975.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 45741.33 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 17646.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16006.27 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17646.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 45741.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16975.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 17646.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16975.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24273.07 } ] } ] }, { "description": "HC ASSAY OF SERUM POTASSIUM", "code_information": [ { "code": "84132", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 37.19, "discounted_cash": 4.0, "minimum": 4.6258, "maximum": 32.4297, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 21.17, "10th_percentile": 19.99, "90th_percentile": 25.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.63, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 18.95, "10th_percentile": 18.95, "90th_percentile": 20.07, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 21.6, "10th_percentile": 20.01, "90th_percentile": 21.6, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.98 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 21.28, "10th_percentile": 21.28, "90th_percentile": 21.28, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.19, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 26.18, "10th_percentile": 26.18, "90th_percentile": 27.47, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC RED BLOOD CELLS, PER UNIT", "code_information": [ { "code": "P9021", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1752.5, "discounted_cash": 149.0, "minimum": 149.83, "maximum": 1528.18, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 149.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 590.27, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 717.04, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 149.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 573.65, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 149.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 149.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 149.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 163.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 149.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 149.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 149.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 149.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 149.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 253.39, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC BRACH ARTERY EXPOS DPLMNT AORTIC/ILIAC PROSTH UNI", "code_information": [ { "code": "34834", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1532.81, "minimum": 459.843, "maximum": 1532.81, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 1532.81 } ] } ] }, { "description": "Levothyroxine Sodium For IV Inj 100 MCG", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "63323088510", "type": "NDC" }, { "code": "J0650", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 15.609, "maximum": 15.609, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.61 } ] } ] }, { "description": "HC GLYCOSYLATED HEMOGLOBIN TEST", "code_information": [ { "code": "83036", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 176.88, "discounted_cash": 9.0, "minimum": 9.4362, "maximum": 154.2394, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 113.2, "10th_percentile": 113.2, "90th_percentile": 113.2, "count": "158" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.79, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 90.14, "10th_percentile": 90.14, "90th_percentile": 123.39, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 97.01, "10th_percentile": 95.19, "90th_percentile": 97.01, "count": "266" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50.95 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 43.4, "10th_percentile": 43.4, "90th_percentile": 113.2, "count": "83" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.58, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 124.52, "10th_percentile": 124.52, "90th_percentile": 124.52, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.42, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF HOMOCYSTINE", "code_information": [ { "code": "83090", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 326.25, "discounted_cash": 17.0, "minimum": 17.4147, "maximum": 284.49, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 175.39, "10th_percentile": 175.39, "90th_percentile": 175.39, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.77, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 17.41, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 166.26, "10th_percentile": 166.26, "90th_percentile": 166.26, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 175.57, "10th_percentile": 175.57, "90th_percentile": 178.94, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 94.03 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 80.1, "10th_percentile": 80.1, "90th_percentile": 208.8, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.53, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 94.03, "10th_percentile": 94.03, "90th_percentile": 94.03, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.31, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Methylprednisolone Sod Succ For Inj PF 125 MG (Base Equiv)", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00009004725", "type": "NDC" }, { "code": "J2919", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 43.31, "10th_percentile": 43.31, "90th_percentile": 159.45, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 51.04, "10th_percentile": 51.04, "90th_percentile": 53.33, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 12.5, "10th_percentile": 12.5, "90th_percentile": 12.5, "count": "1 through 10" } ] } ] }, { "description": "Hydromorphone HCl-NaCl Soln Pref Syr 25 MG/50ML-0.9%", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "09999408226", "type": "NDC" }, { "code": "J1171", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 23.98, "10th_percentile": 11.99, "90th_percentile": 39.11, "count": "19" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 14.84, "10th_percentile": 11.99, "90th_percentile": 44.53, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 16.49, "10th_percentile": 16.49, "90th_percentile": 16.49, "count": "1 through 10" } ] } ] }, { "description": "HC PERCUTANEOUS TRANSLUMINAL CORONARY LITHOTRIPSY", "code_information": [ { "code": "92972", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13833.8, "minimum": 4150.14, "maximum": 12063.0736, "payers_information": [ { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 28117.51, "10th_percentile": 28117.51, "90th_percentile": 28117.51, "count": "1 through 10" } ] } ] }, { "description": "Piperacillin Sod-Tazobactam Sod For Inj 2.25 GM (2-0.25 GM)", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "55150011930", "type": "NDC" }, { "code": "J2543", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2.408, "maximum": 2.408, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 72.41, "10th_percentile": 72.41, "90th_percentile": 72.41, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2.41 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 85.34, "10th_percentile": 85.34, "90th_percentile": 170.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 99.93, "10th_percentile": 99.93, "90th_percentile": 99.93, "count": "1 through 10" } ] } ] }, { "description": "HC RENAL IMAGING WITH FLOW", "code_information": [ { "code": "78701", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 788.13, "discounted_cash": 394.0, "minimum": 236.439, "maximum": 788.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 788.13, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 788.13, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 788.13, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 788.13 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC NON-INVASIVE LOWR EXTRM ART STRSS/REST COMPLT BILAT", "code_information": [ { "code": "93924", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 910.31, "discounted_cash": 213.0, "minimum": 213.05, "maximum": 910.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 839.33, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 910.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 815.7, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 360.31, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY ANKLE 3+ VW", "code_information": [ { "code": "73610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 483.44, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 421.5597, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 291.8, "10th_percentile": 245.11, "90th_percentile": 291.8, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 410.95, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 231.25, "10th_percentile": 231.25, "90th_percentile": 231.25, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 294.97, "10th_percentile": 283.56, "90th_percentile": 294.97, "count": "13" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 248.66 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 110.5, "10th_percentile": 110.5, "90th_percentile": 110.5, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 320.98, "10th_percentile": 296.48, "90th_percentile": 337.25, "count": "17" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REPAIR VESSEL DIRECT LOWER EXTREM", "code_information": [ { "code": "35226", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4921.25, "discounted_cash": 698.0, "minimum": 698.71, "maximum": 4291.33, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2752.64, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3343.82, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2675.15, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 761.59, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1181.66, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Mycophenolate Mofetil Cap 250 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "60687088511", "type": "NDC" }, { "code": "J7517", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "718", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11262.0, "minimum": 8526.39, "maximum": 24269.6021, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10849.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 24269.6 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10849.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10849.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 17147.4 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 11262.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8526.39 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11262.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17147.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10849.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 11262.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10849.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14937.53 } ] } ] }, { "description": "HC IADNA HIV-1 QUANT & REVERSE TRANSCRIPTION", "code_information": [ { "code": "87536", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 790.0, "discounted_cash": 85.0, "minimum": 82.7002, "maximum": 688.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 477.0, "10th_percentile": 477.0, "90th_percentile": 477.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 85.1, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 103.37, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 82.7, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 408.79, "10th_percentile": 408.79, "90th_percentile": 425.15, "count": "14" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 446.54 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 380.4, "10th_percentile": 380.4, "90th_percentile": 380.4, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 92.76, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 551.1, "10th_percentile": 551.1, "90th_percentile": 551.1, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 143.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REPAIR TONGUE LACER,<2.6 CM", "code_information": [ { "code": "41250", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 540.63, "discounted_cash": 440.0, "minimum": 162.189, "maximum": 540.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 540.63, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 540.63, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 540.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 480.45, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 540.63, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PERQ MECHAN THROMBECTOMY VENOUS", "code_information": [ { "code": "37187", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12674.1, "discounted_cash": 11390.0, "minimum": 3802.23, "maximum": 12674.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12674.1, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 12674.1, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12674.1, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12415.84, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12674.1, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "512", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13638.0, "minimum": 11128.11, "maximum": 47369.9612, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13128.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 29912.81 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13128.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13128.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 31559.32 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 13638.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11128.11 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13638.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 31559.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13128.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 13638.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13128.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18410.83 } ] } ] }, { "description": "HC CLSD TREAT PROX/MID FING SHFT FX W MANIP EA", "code_information": [ { "code": "26725", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 452.19, "discounted_cash": 243.0, "minimum": 135.657, "maximum": 452.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 452.19, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 452.19, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 452.19, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 411.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH MCC", "code_information": [ { "code": "510", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24020.0, "minimum": 19781.85, "maximum": 67794.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 23090.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 54579.95 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 23090.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 23090.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 67794.67 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 24020.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19781.85 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24020.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 67794.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 23090.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 24020.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 23090.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 33593.03 } ] } ] }, { "description": "HC REMOVAL FOREIGN BODY INTRANASAL GENERAL ANES", "code_information": [ { "code": "30310", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2236.88, "discounted_cash": 3271.0, "minimum": 671.064, "maximum": 2236.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2236.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2236.88, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2236.88, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2236.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2236.88, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2236.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2236.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2236.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2236.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2236.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2236.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2236.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2236.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2236.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2236.88, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL Q4101) APLIGRAF PER SQ CM", "code_information": [ { "code": "Q4101", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 65.274, "maximum": 605.4868, "payers_information": [ { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 65.27 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC", "code_information": [ { "code": "823", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 35917.0, "minimum": 32388.36, "maximum": 102093.36, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 34506.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 82846.6 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 34506.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 34506.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 102093.36 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 35917.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32388.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 35917.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 102093.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 34506.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 35917.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 34506.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 50990.68 } ] } ] }, { "description": "HIV WITH MAJOR RELATED CONDITION WITH MCC", "code_information": [ { "code": "974", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22997.0, "minimum": 20668.48, "maximum": 52149.5582, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 22109.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 52149.56 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 22109.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 22109.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 37180.3 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 22997.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20668.48 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22997.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 37180.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 22109.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 22997.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 22109.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 32097.17 } ] } ] }, { "description": "HC OSTEOPATHIC MANIPULATIVE TX 1-2 BODY REGIONS", "code_information": [ { "code": "98925", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 163.44, "discounted_cash": 21.0, "minimum": 21.31, "maximum": 142.5197, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 83.95, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 101.98, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 81.59, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 21.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 21.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.23, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 21.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.04, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC THROMBOLYSIS VENOUS INFUSION W/IMAGING INIT TX", "code_information": [ { "code": "37212", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3611.56, "discounted_cash": 3115.0, "minimum": 1083.468, "maximum": 3611.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3611.56, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3611.56, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3611.56, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3611.56, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC COMPATIBILITY TEST,SPIN TECH", "code_information": [ { "code": "86920", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 105.63, "discounted_cash": 168.0, "minimum": 31.689, "maximum": 105.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 105.63, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 105.63, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 105.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 105.63 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 105.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 105.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 105.63, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 105.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 105.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 105.63, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "DEEP VEIN THROMBOPHLEBITIS WITHOUT CCMCC", "code_information": [ { "code": "295", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5466.47, "maximum": 5466.47, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5466.47 } ] } ] }, { "description": "HEADACHES WITH MCC", "code_information": [ { "code": "102", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9572.0, "minimum": 8025.28, "maximum": 31304.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9228.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 20254.48 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9228.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9228.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 31304.09 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9572.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8025.28 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9572.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 31304.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9228.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 9572.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9228.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12466.29 } ] } ] }, { "description": "HC ELECTRIC CURRENT THER, IONTOPHORESIS EA 15 MIN", "code_information": [ { "code": "97033", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 128.75, "discounted_cash": 18.0, "minimum": 17.5993, "maximum": 112.27, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.11, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.0, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 17.6, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.63, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PERQ XHEPATIC PORTOGRAM", "code_information": [ { "code": "75887", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3955.63, "discounted_cash": 3115.0, "minimum": 640.6242, "maximum": 3955.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3955.63, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3955.63, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3955.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 640.62 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3955.63, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITHOUT CCMCC", "code_information": [ { "code": "730", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6158.0, "minimum": 4200.56, "maximum": 14532.72, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5952.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 12142.93 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 5952.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 5952.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 14532.72 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6158.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4200.56 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6158.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14532.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5952.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 6158.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 5952.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7473.77 } ] } ] }, { "description": "Phytonadione Inj 10 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "43598040511", "type": "NDC" }, { "code": "J3430", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 5.2675, "maximum": 5.2675, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.27 } ] } ] }, { "description": "HC REVASC INTRAVASC LITHOTRIPSY", "code_information": [ { "code": "C9764", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 43887.8, "discounted_cash": 11390.0, "minimum": 11390.68, "maximum": 43887.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 43887.8, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 43887.8, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 43611.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12415.84, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19263.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL Q4169) ARTACENT WOUND, PER SQ CM", "code_information": [ { "code": "Q4169", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 126.52, "maximum": 605.4868, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 378.53 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY GLUCOSE, BODY FLUID", "code_information": [ { "code": "82945", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 71.25, "discounted_cash": 3.0, "minimum": 3.8192, "maximum": 62.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.77, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3.82, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 36.31, "10th_percentile": 36.31, "90th_percentile": 36.31, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 39.08, "10th_percentile": 39.08, "90th_percentile": 39.08, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.62 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 17.57, "10th_percentile": 17.57, "90th_percentile": 17.57, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.65, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY WITH C.D.E. WITHOUT CCMCC", "code_information": [ { "code": "413", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13676.0, "minimum": 11506.71, "maximum": 48153.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13165.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 30004.97 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13165.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13165.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 48153.39 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 13676.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11506.71 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13676.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 48153.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13165.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 13676.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13165.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18467.55 } ] } ] }, { "description": "HC INJ DX/THR PARAVRT FACET JNT IMG LUMB/SAC 1ST LVL", "code_information": [ { "code": "64493", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3721.88, "discounted_cash": 872.0, "minimum": 872.7, "maximum": 3721.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1995.15, "10th_percentile": 1995.15, "90th_percentile": 1995.15, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3438.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3721.88, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3341.31, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 2992.72, "10th_percentile": 2992.72, "90th_percentile": 2992.72, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 951.24, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 3523.07, "10th_percentile": 3523.07, "90th_percentile": 3523.07, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1475.91, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DOPPLER FETAL UMBILICAL ARTERY", "code_information": [ { "code": "76820", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 516.56, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 493.645, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 187.24 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "SALIVARY GLAND PROCEDURES", "code_information": [ { "code": "139", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10446.0, "minimum": 9502.99, "maximum": 26723.52, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10065.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 22328.9 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10065.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10065.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 26723.52 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 10446.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9502.99 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10446.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26723.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10065.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 10446.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10065.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13743.06 } ] } ] }, { "description": "HC (SUP SHELL A2006) NOVOSORB SYNPATH PER SQ CM", "code_information": [ { "code": "A2006", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 126.52, "maximum": 605.4868, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC NM PARATHYROID PLANAR IMAGING", "code_information": [ { "code": "78070", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 842.19, "discounted_cash": 394.0, "minimum": 252.657, "maximum": 842.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 842.19, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 842.19, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 842.19, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 842.19 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC FERN TEST - 87210 - 30600080", "code_information": [ { "code": "87210", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 88.13, "discounted_cash": 5.0, "minimum": 5.6559, "maximum": 76.8494, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.82, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.07, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.66, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.54 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.34, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.84, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CT ORBIT/SELLA/POST FOSSA/EAR WO/W CONTR", "code_information": [ { "code": "70482", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2515.31, "discounted_cash": 173.0, "minimum": 173.07, "maximum": 2193.3503, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 681.83, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 828.26, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 662.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1377.74 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 292.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC TRANSFERASE ALANINE AMINO (ALT) (SGPT)", "code_information": [ { "code": "84460", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 90.0, "discounted_cash": 5.0, "minimum": 5.1505, "maximum": 78.48, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 69.0, "10th_percentile": 48.0, "90th_percentile": 69.0, "count": "28" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.44, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.15, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 54.94, "10th_percentile": 54.94, "90th_percentile": 54.94, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 58.02, "10th_percentile": 58.02, "90th_percentile": 59.13, "count": "36" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.81 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 23.69, "10th_percentile": 23.69, "90th_percentile": 23.69, "count": "19" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 75.21, "10th_percentile": 27.72, "90th_percentile": 75.9, "count": "47" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.96, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC THROMBOLYTIC THERAPY, STROKE", "code_information": [ { "code": "37195", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3243.13, "discounted_cash": 325.0, "minimum": 325.91, "maximum": 2828.0094, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1283.96, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1559.71, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1247.81, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 355.24, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 551.18, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT PROX/MID FING SHFT FX WO MANIP EA", "code_information": [ { "code": "26720", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 688.44, "discounted_cash": 243.0, "minimum": 206.532, "maximum": 688.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 688.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 688.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 688.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 411.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REVSC EVASC TPVT ATHRC UNI SF LES 1ST VSL", "code_information": [ { "code": "37288", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 88727.2, "discounted_cash": 18087.0, "minimum": 18087.87, "maximum": 86563.1195, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 71258.97, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 86563.12, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 69253.03, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19715.78, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30590.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Rasburicase For IV Soln 1.5 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00024515010", "type": "NDC" }, { "code": "J2783", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 382.0, "minimum": 366.8739, "maximum": 1505.6639, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1505.66, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 458.57, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 366.87, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 796.49 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 382.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 382.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 416.58, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 382.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 382.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 646.35, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HYPERTENSIVE ENCEPHALOPATHY WITHOUT CCMCC", "code_information": [ { "code": "079", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4579.15, "maximum": 4579.15, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4579.15 } ] } ] }, { "description": "HC ALPHA-1-ANTITRYPSIN, TOTAL", "code_information": [ { "code": "82103", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 203.13, "discounted_cash": 13.0, "minimum": 13.061, "maximum": 177.1294, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 60.08, "10th_percentile": 60.08, "90th_percentile": 60.08, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.33, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13.06, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 103.51, "10th_percentile": 103.51, "90th_percentile": 103.51, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 109.31, "10th_percentile": 109.31, "90th_percentile": 109.31, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70.52 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 70.52, "10th_percentile": 13.44, "90th_percentile": 143.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.73, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REMOVAL PERQ R HEART VAD VENOUS CANNULA SEP INSJ", "code_information": [ { "code": "33997", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2071.56, "minimum": 621.468, "maximum": 2071.56, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 2071.56 } ] } ] }, { "description": "HC ARTHROGRAM OF KNEE JOINT", "code_information": [ { "code": "73580", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 657.81, "discounted_cash": 344.0, "minimum": 197.343, "maximum": 657.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 657.81, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 657.81, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 657.81, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 657.81 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Regadenoson IV Inj 0.4 MG/5ML (0.08 MG/ML)", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "76329332100", "type": "NDC" }, { "code": "J2785", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 9.4815, "maximum": 9.4815, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 151.87, "10th_percentile": 151.87, "90th_percentile": 151.87, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.48 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 90.0, "10th_percentile": 90.0, "90th_percentile": 178.99, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL A4615) CANNULA NASAL - A4615 - RU272033", "code_information": [ { "code": "A4615", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 1.0, "minimum": 1.0107, "maximum": 1.7588, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.04, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.26, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.01, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1.76, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ANGIO EXTERMITY BILAT", "code_information": [ { "code": "75716", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10259.7, "discounted_cash": 3115.0, "minimum": 631.8398, "maximum": 10259.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10259.7, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10259.7, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 10259.7, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 631.84 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5268.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CHEST X-RAY W APICAL LORD", "code_information": [ { "code": "71047", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 319.06, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 319.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 319.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 319.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 319.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 257.44 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DRUG SCREEN QUANTITATIVE LEVETIRACETAM", "code_information": [ { "code": "80177", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 265.63, "discounted_cash": 13.0, "minimum": 12.8764, "maximum": 231.6294, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 69.53 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.44, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 69.53, "10th_percentile": 69.53, "90th_percentile": 185.3, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 160.4, "10th_percentile": 160.4, "90th_percentile": 160.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.09, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" } ] } ] }, { "description": "SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITH CCMCC", "code_information": [ { "code": "537", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8305.0, "minimum": 6360.7, "maximum": 20638.84, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8012.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 17244.05 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8012.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8012.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 20638.84 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8305.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6360.7 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8305.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20638.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8012.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8305.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8012.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10613.42 } ] } ] }, { "description": "HYPERTENSION WITHOUT MCC", "code_information": [ { "code": "305", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6790.0, "minimum": 5195.84, "maximum": 16111.4503, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6558.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 13644.54 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6558.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6558.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 12286.28 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6790.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5195.84 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6790.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12286.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6558.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 6790.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6558.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8397.98 } ] } ] }, { "description": "O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CCMCC", "code_information": [ { "code": "941", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16469.0, "minimum": 13526.36, "maximum": 48997.03, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15845.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 36640.21 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 15845.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 15845.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 48997.03 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 16469.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13526.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16469.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 48997.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15845.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 16469.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15845.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22551.43 } ] } ] }, { "description": "HC AMNIOCENTESIS,DIAGNOSTIC", "code_information": [ { "code": "59000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 575.63, "discounted_cash": 908.0, "minimum": 172.689, "maximum": 575.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 575.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 575.63, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 575.63, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 575.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 575.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 575.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 575.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 575.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 575.63, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 575.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 575.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 575.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 575.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 575.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 575.63, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "SINUS AND MASTOID PROCEDURES WITH CCMCC", "code_information": [ { "code": "135", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17551.0, "minimum": 16688.02, "maximum": 46929.83, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16884.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 39211.55 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 16884.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 16884.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 46929.83 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 17551.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16688.02 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17551.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 46929.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16884.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 17551.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16884.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24134.05 } ] } ] }, { "description": "VIRAL ILLNESS WITH MCC", "code_information": [ { "code": "865", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12443.0, "minimum": 8879.8257, "maximum": 32063.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11982.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 27074.04 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11982.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11982.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 32063.94 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12443.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10039.39 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12443.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32063.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11982.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 12443.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11982.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16663.61 } ] } ] }, { "description": "Pamidronate Disodium IV Soln 9 MG/ML", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "67457044610", "type": "NDC" }, { "code": "J2430", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 29.842, "maximum": 29.842, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.84 } ] } ] }, { "description": "RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS", "code_information": [ { "code": "207", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 49986.0, "minimum": 44761.63, "maximum": 128380.8259, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 115572.19, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 50383.86, "10th_percentile": 50383.86, "90th_percentile": 50383.86, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 48006.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 116274.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 48006.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 112642.4, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 117750.1, "10th_percentile": 117750.1, "90th_percentile": 117750.1, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 48006.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 127756.99 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 49986.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44761.63 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 49986.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 127757.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 48006.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 49986.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 48006.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 71564.67 } ] } ] }, { "description": "HC (SUP SHELL Q4010) CAST SUP SHT ARM ADULT FBRGL", "code_information": [ { "code": "Q4010", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 24.0, "minimum": 24.1006, "maximum": 41.9418, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 24.8, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 30.12, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 24.1, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 24.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 24.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.03, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 24.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.94, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC IMMUNOFLUOR EA ADD SINGLE ANTIBODY STAIN", "code_information": [ { "code": "88350", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 248.44, "minimum": 74.532, "maximum": 248.44, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 248.44 } ] } ] }, { "description": "HC FATS/LIPIDS, FECES, QUANTITATIVE", "code_information": [ { "code": "82710", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 241.88, "discounted_cash": 16.0, "minimum": 16.3262, "maximum": 210.9194, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.41, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 16.33, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 88.15 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.41, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC COLORECTAL CANCER SCREEN, SIGMOID, BA ENEMA - 74270 - 32000239", "code_information": [ { "code": "74270", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 401.56, "discounted_cash": 173.0, "minimum": 120.468, "maximum": 401.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 321.25, "10th_percentile": 321.25, "90th_percentile": 321.25, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 401.56, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 401.56, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 401.56, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 401.56 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 292.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF CYCLOSPORINE", "code_information": [ { "code": "80158", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 336.88, "discounted_cash": 18.0, "minimum": 17.541, "maximum": 293.7594, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.53, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.93, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 17.54, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 94.71 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.67, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Oxytocin Inj 10 Unit/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "63323001203", "type": "NDC" }, { "code": "J2590", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 3.0745, "maximum": 3.0745, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.07 } ] } ] }, { "description": "HC X-RAY GUIDE, GU DILATION", "code_information": [ { "code": "74485", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10138.1, "discounted_cash": 2062.0, "minimum": 710.7578, "maximum": 9870.8891, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8125.74, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9870.89, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7897.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 710.76 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2248.21, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3488.24, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY SALIVARY GLAND", "code_information": [ { "code": "70380", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 916.88, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 799.5194, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 410.95, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 260.34 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DETECT AGENT NOS, DNA, AMP", "code_information": [ { "code": "87798", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 345.63, "discounted_cash": 35.0, "minimum": 34.1005, "maximum": 301.3894, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 44.8, "10th_percentile": 37.63, "90th_percentile": 44.8, "count": "27" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 42.62, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 34.1, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 37.74, "10th_percentile": 37.74, "90th_percentile": 3650.0, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 39.86, "10th_percentile": 33.88, "90th_percentile": 771.64, "count": "35" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 184.12 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 59.25, "10th_percentile": 44.8, "90th_percentile": 627.41, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 56.0, "10th_percentile": 49.28, "90th_percentile": 1040.51, "count": "66" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 59.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC THER IVNT COG FUNCJ CNTCT EA ADDL 15 MINUTES", "code_information": [ { "code": "97130", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 116.25, "discounted_cash": 18.0, "minimum": 17.6673, "maximum": 101.37, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.18, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.08, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 17.67, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.82, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CULTURE, CHLAMYDIA", "code_information": [ { "code": "87110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 306.88, "discounted_cash": 19.0, "minimum": 19.0473, "maximum": 267.5994, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 19.6, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.81, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 19.05, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 102.85 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 19.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 19.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.36, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 19.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.15, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ENDOVEN ABLT INCMPTNT VEIN MCHNCHEM EXTR 1ST VEIN", "code_information": [ { "code": "36473", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12432.8, "discounted_cash": 3115.0, "minimum": 3115.49, "maximum": 12432.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12273.78, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 12432.8, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11928.28, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5268.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MAMMARY DUCTOGRAM, SINGLE", "code_information": [ { "code": "77053", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 533.13, "discounted_cash": 235.0, "minimum": 159.939, "maximum": 533.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 533.13, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 533.13, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 533.13, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 324.67 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 256.61, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL C1887) CATHETER GUIDING", "code_information": [ { "code": "C1887", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 80.66, "10th_percentile": 80.66, "90th_percentile": 80.66, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 90.08, "10th_percentile": 49.83, "90th_percentile": 164.82, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 181.17, "10th_percentile": 181.17, "90th_percentile": 181.17, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 130.8, "10th_percentile": 122.1, "90th_percentile": 517.97, "count": "1 through 10" } ] } ] }, { "description": "HC NUCLEAR THERAPY, IV", "code_information": [ { "code": "79101", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 746.25, "discounted_cash": 230.0, "minimum": 223.875, "maximum": 746.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 746.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 746.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 746.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 470.96 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 250.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 389.36, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6022) COLLAGEN DRSG>16<=48 SQ IN - A6022 - RU272039", "code_information": [ { "code": "A6022", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 29.0, "minimum": 29.1248, "maximum": 50.6853, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 29.97, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 36.4, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 29.12, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 29.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 29.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.67, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 29.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50.69, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC POLYSOM 6/>YRS SLEEP W/CPAP 4/> ADDL PARAM ATTND", "code_information": [ { "code": "95811", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5919.69, "discounted_cash": 847.0, "minimum": 847.32, "maximum": 5161.9697, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3244.13, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 847.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 847.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 847.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 923.58, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 847.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 847.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 847.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 847.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 847.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1432.99, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 847.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3338.1, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4055.02, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 847.32, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MEDICAL BACK PROBLEMS WITH MCC", "code_information": [ { "code": "551", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13795.0, "minimum": 11810.56, "maximum": 32090.5112, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13279.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 30286.86 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13279.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13279.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 22158.54 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 13795.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11810.56 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13795.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22158.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 32090.51, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 19557.11, "10th_percentile": 19557.11, "90th_percentile": 19557.11, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13279.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 13795.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13279.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18641.05 } ] } ] }, { "description": "LIVER TRANSPLANT WITHOUT MCC", "code_information": [ { "code": "006", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 36314.0, "minimum": 33562.91, "maximum": 106374.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 34887.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 83789.85 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 34887.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 34887.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 106373.88 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 36314.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33562.91 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 36314.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 106374.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 34887.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 36314.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 34887.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 51571.23 } ] } ] }, { "description": "HC PHOSPHOLIPID NEUTRALIZ, HEXAGONAL PHOSPHOLIPID", "code_information": [ { "code": "85598", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 124.69, "discounted_cash": 17.0, "minimum": 17.473, "maximum": 108.7297, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.84, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 17.47, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 94.34 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.41, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC US GUIDE AMNIOCENTESIS", "code_information": [ { "code": "76946", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1071.56, "minimum": 134.529, "maximum": 934.4003, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 134.53 } ] } ] }, { "description": "HC (SUP SHELL A6251) ABSORPT DRG <=16 SQ IN W/O B", "code_information": [ { "code": "A6251", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 2.0, "minimum": 2.7599, "maximum": 4.803, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2.84, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.45, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2.76, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.1, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.8, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY BLOOD CARBON MONOXIDE", "code_information": [ { "code": "82375", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 220.63, "discounted_cash": 12.0, "minimum": 11.9726, "maximum": 192.3894, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.97, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.97, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 64.65 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 64.43, "10th_percentile": 64.43, "90th_percentile": 64.43, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.84, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CATH PLC/COR ANGIO RS/I BYPASS ANGIO", "code_information": [ { "code": "93455", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16181.9, "discounted_cash": 3198.0, "minimum": 3198.82, "maximum": 15308.5929, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12602.07, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15308.59, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12247.32, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3486.71, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5409.84, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Lidocaine HCl Local Inj 2%", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "55150025410", "type": "NDC" }, { "code": "J2003", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 11.99, "10th_percentile": 11.99, "90th_percentile": 12.71, "count": "14" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 14.84, "10th_percentile": 14.13, "90th_percentile": 25.07, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 15.7, "10th_percentile": 15.7, "90th_percentile": 15.7, "count": "1 through 10" } ] } ] }, { "description": "Filgrastim-aafi Soln Prefilled Syringe 480 MCG/0.8ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00069029201", "type": "NDC" }, { "code": "Q5110", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.1188, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.12, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL C1781) MESH", "code_information": [ { "code": "C1781", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 867.89, "10th_percentile": 867.89, "90th_percentile": 867.89, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 990.06, "10th_percentile": 990.06, "90th_percentile": 1751.11, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 1196.54, "10th_percentile": 1196.54, "90th_percentile": 1196.54, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 2464.22, "10th_percentile": 1912.68, "90th_percentile": 3578.52, "count": "1 through 10" } ] } ] }, { "description": "DENTAL AND ORAL DISEASES WITH CC", "code_information": [ { "code": "158", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7967.0, "minimum": 6510.2, "maximum": 20186.1024, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7687.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 16439.94 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7687.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7687.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 12769.47 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7967.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6510.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7967.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12769.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7687.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7967.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7687.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10118.5 } ] } ] }, { "description": "HC REPR WND INTRMD BODY/SCALP/EXTR 12.5-20 CM", "code_information": [ { "code": "12035", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 698.44, "discounted_cash": 401.0, "minimum": 209.532, "maximum": 698.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 437.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 678.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Clevidipine IV Emulsion 25 MG/50ML", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "10122061001", "type": "NDC" }, { "code": "C9248", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 2.0, "minimum": 2.88, "maximum": 13.7828, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.35, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.78, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.03, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.74 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.14, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.87, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REPLACE CV CATH CATHETER ONLY W SUBQ PUMP/PORT", "code_information": [ { "code": "36578", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1545.94, "discounted_cash": 3115.0, "minimum": 463.782, "maximum": 1545.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1545.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1545.94, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1545.94, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1545.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1545.94, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1545.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1545.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1545.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1545.94, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1545.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1545.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1545.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1545.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1545.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1545.94, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ENDOVASC INTRACRANIAL PRLNG ADMIN RX AGENT, ADDL", "code_information": [ { "code": "61651", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1244.38, "minimum": 373.314, "maximum": 1244.38, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 1244.38 } ] } ] }, { "description": "HC MYELOGRAPHY LUMBAR INJ, LUMBOSCRAL", "code_information": [ { "code": "62304", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1485.63, "discounted_cash": 773.0, "minimum": 445.689, "maximum": 1485.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1485.63, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1485.63, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1485.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 843.1, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 996.16, "10th_percentile": 996.16, "90th_percentile": 996.16, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1308.13, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4346) CATH INDW FOLEY 3 WAY - A4346 - 27200066", "code_information": [ { "code": "A4346", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 23.0, "minimum": 23.0511, "maximum": 40.1153, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 23.72, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 28.81, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 23.05, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 23.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 23.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.85, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 23.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 23.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.12, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6410) STERILE EYE PAD - A6410 - RU272062", "code_information": [ { "code": "A6410", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC RENAL BIOPSY PERQ", "code_information": [ { "code": "50200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2355.31, "discounted_cash": 1629.0, "minimum": 706.593, "maximum": 2355.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1421.24, "10th_percentile": 1421.24, "90th_percentile": 1479.14, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2355.31, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2355.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2355.31, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1437.12, "10th_percentile": 1437.12, "90th_percentile": 1437.12, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 1444.47, "10th_percentile": 1444.47, "90th_percentile": 1444.47, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1776.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2355.31, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "822", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10204.0, "minimum": 7915.93, "maximum": 26540.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9834.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 21756.09 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9834.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9834.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 26540.38 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 10204.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7915.93 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10204.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26540.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9834.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 10204.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9834.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13390.5 } ] } ] }, { "description": "HC REPR WND INTRMD FACE 5.1-7.5 CM", "code_information": [ { "code": "12053", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 698.44, "discounted_cash": 401.0, "minimum": 209.532, "maximum": 698.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 437.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 678.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DRESS/DEBRIDE BURN 5-10% TTL MED", "code_information": [ { "code": "16025", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 883.44, "discounted_cash": 197.0, "minimum": 197.97, "maximum": 883.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 779.92, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 883.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 757.97, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 215.79, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 334.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC", "code_information": [ { "code": "922", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14352.0, "minimum": 11692.89, "maximum": 41262.6243, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13814.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 31611.38 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13814.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13814.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 25955.87 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14352.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11692.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14352.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25955.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13814.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 14352.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13814.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19456.27 } ] } ] }, { "description": "HC PERQ PLCMT BILE DUCT STENT, EXISTING ACCESS", "code_information": [ { "code": "47538", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20037.2, "discounted_cash": 5965.0, "minimum": 5965.14, "maximum": 20037.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 20037.2, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 20037.2, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 20037.2, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6502.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10088.24, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ERCP REMOV CALCULI/DEBRIS BILIARY/PANCREAS DUCT", "code_information": [ { "code": "43264", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7151.56, "discounted_cash": 3804.0, "minimum": 2145.468, "maximum": 7151.56, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7151.56, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4146.58, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6433.66, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1153.08, "10th_percentile": 1153.08, "90th_percentile": 1153.08, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7151.56, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7151.56, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC", "code_information": [ { "code": "309", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6643.0, "minimum": 5116.94, "maximum": 20387.5574, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 18353.48, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 12860.37, "10th_percentile": 12860.37, "90th_percentile": 12860.37, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6416.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 13293.98 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6416.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 17832.1, "standard_charge_algorithm": "76.27% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 18447.32, "10th_percentile": 18447.32, "90th_percentile": 18447.32, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 17888.21, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 11914.91, "10th_percentile": 11914.91, "90th_percentile": 14587.72, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6416.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 10476.26 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "other", "standard_charge_dollar": 20340.8, "standard_charge_algorithm": "87% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 8516.91, "10th_percentile": 8516.91, "90th_percentile": 8516.91, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6643.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5116.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6643.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10476.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6416.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 6643.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6416.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8182.22 } ] } ] }, { "description": "HC X-RAY TMJ UNILAT", "code_information": [ { "code": "70328", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 387.81, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 387.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 387.81, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 228.18 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Levofloxacin in D5W IV Soln 250 MG/50ML", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "00143972201", "type": "NDC" }, { "code": "J1956", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2.2145, "maximum": 2.2145, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2.21 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 21.73, "10th_percentile": 21.73, "90th_percentile": 21.73, "count": "1 through 10" } ] } ] }, { "description": "SPINAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "030", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17743.0, "minimum": 15402.73, "maximum": 39666.9128, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17068.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 39666.91 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 17068.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 17068.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 38717.54 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 17743.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15402.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17743.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 38717.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17068.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 17743.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17068.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24414.31 } ] } ] }, { "description": "HC REPR WND CPLX FACE/HND/FT/GENT 1.1-2.5 CM", "code_information": [ { "code": "13131", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1836.25, "discounted_cash": 401.0, "minimum": 401.1, "maximum": 1836.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1580.17, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1836.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1535.69, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 437.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 678.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Aztreonam For Inj 2 GM", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "63323040201", "type": "NDC" }, { "code": "J0457", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 5.332, "maximum": 5.332, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.33 } ] } ] }, { "description": "HC (SUP SHELL L8614) COCHLEAR DEVICE", "code_information": [ { "code": "L8614", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 23439.0, "minimum": 22778.5741, "maximum": 39641.0008, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23439.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 23439.57, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 28472.05, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23439.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 22778.57, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23439.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 23439.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 23439.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25549.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23439.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 23439.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23439.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 23439.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23439.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39641.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC", "code_information": [ { "code": "288", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21629.0, "minimum": 18905.61, "maximum": 89036.5521, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 20797.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 48900.6 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 20797.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 20797.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 58526.39 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 21629.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18905.61 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21629.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 58526.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 20797.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 21629.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 20797.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30097.49 } ] } ] }, { "description": "HC WESTERN BLOT TEST", "code_information": [ { "code": "84181", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 267.81, "discounted_cash": 17.0, "minimum": 16.5498, "maximum": 233.5303, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.69, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 16.55, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 89.36 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.56, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.8, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF URINE VMA", "code_information": [ { "code": "84585", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 268.75, "discounted_cash": 15.0, "minimum": 15.0629, "maximum": 234.35, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.83, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 15.06, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 81.33 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.9, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC KRAS GENE ANALYSIS ADDITIONAL VARIANT(S)", "code_information": [ { "code": "81276", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 989.38, "discounted_cash": 193.0, "minimum": 187.8004, "maximum": 989.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 193.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 193.25, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 234.74, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 193.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 187.8, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 989.38 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 193.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 193.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 193.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 210.64, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 193.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 193.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 193.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 193.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 193.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 326.82, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CATH PLC/COR ANGIO RS/IN W RIGHT HEART CATH", "code_information": [ { "code": "93456", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16181.9, "discounted_cash": 3198.0, "minimum": 3198.82, "maximum": 15308.5929, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5409.84, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12602.07, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15308.59, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12247.32, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3486.71, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT RADIAL SHAFT FX W MANIP", "code_information": [ { "code": "25505", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 715.94, "discounted_cash": 1586.0, "minimum": 214.782, "maximum": 715.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 715.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 715.94, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 715.94, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 715.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 715.94, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 715.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 715.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 715.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 715.94, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 715.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 715.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 715.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 715.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 715.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 715.94, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PERQ BREAST LOC DEV PLACE MRI GUIDE ADDL LESION", "code_information": [ { "code": "19288", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2553.13, "minimum": 765.939, "maximum": 2226.3294, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 } ] } ] }, { "description": "HC RO SET RADN THERAPY FIELD SIMPLE", "code_information": [ { "code": "77280", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1289.06, "discounted_cash": 132.0, "minimum": 132.62, "maximum": 1124.0603, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 132.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 522.47, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 634.68, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 132.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 507.76, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 132.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 132.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 132.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 144.56, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 132.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 132.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 132.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 132.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 132.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 224.29, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC IMMUNOASSAY, TUMOR ANTIGEN, QUANT", "code_information": [ { "code": "86316", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 220.94, "discounted_cash": 20.0, "minimum": 20.2232, "maximum": 192.6597, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.28, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 20.22, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 118.9, "10th_percentile": 118.9, "90th_percentile": 118.9, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 109.19 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.68, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 146.74, "10th_percentile": 146.74, "90th_percentile": 146.74, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.19, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ENDOMYOCARDIAL BIOPSY", "code_information": [ { "code": "93505", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15604.4, "discounted_cash": 3115.0, "minimum": 3115.49, "maximum": 14909.8005, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12273.78, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14909.8, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11928.28, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5268.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ANTIBODY DETECTION NOS IF", "code_information": [ { "code": "87299", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 207.81, "discounted_cash": 16.0, "minimum": 15.646, "maximum": 181.2103, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.56, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 15.65, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 84.48 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.55, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.23, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC RBC DEGLYCEROLIZED, PER UNIT", "code_information": [ { "code": "P9039", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2745.94, "discounted_cash": 311.0, "minimum": 311.47, "maximum": 2394.4597, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 311.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1227.07, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1490.6, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 311.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1192.53, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 311.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 311.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 311.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 339.5, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 311.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 311.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 311.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 311.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 311.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 526.76, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "GASTROINTESTINAL HEMORRHAGE WITH MCC", "code_information": [ { "code": "377", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14950.0, "minimum": 12584.36, "maximum": 44827.6325, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14388.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 33031.67 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14388.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 39208.76, "standard_charge_algorithm": "76.27% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 22345.08, "10th_percentile": 22345.08, "90th_percentile": 22345.08, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14388.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 28278.3 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14950.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12584.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14950.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 28278.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14388.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 14950.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14388.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20330.43 } ] } ] }, { "description": "HC URETERAL REFLUX STUDY", "code_information": [ { "code": "78740", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1004.38, "discounted_cash": 394.0, "minimum": 301.314, "maximum": 1004.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1004.38, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1004.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1004.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1004.38 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS WITH PRINCIPAL DIAGNOSIS PULMONARY EMBOLISM", "code_information": [ { "code": "173", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23684.0, "minimum": 21238.79, "maximum": 64369.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 22769.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 53783.07 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 22769.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 22769.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 64369.48 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 23684.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21238.79 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23684.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 64369.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 22769.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 23684.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 22769.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 33102.57 } ] } ] }, { "description": "HC MRI CHEST WO/W CONTRAST", "code_information": [ { "code": "71552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3750.94, "discounted_cash": 344.0, "minimum": 344.22, "maximum": 3328.7239, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1356.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1647.33, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1317.92, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3328.72 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REMOVAL TUNNELED CV CATH W/O SUBQ PORT OR PUMP", "code_information": [ { "code": "36589", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2921.88, "discounted_cash": 618.0, "minimum": 618.95, "maximum": 2921.88, "payers_information": [ { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 674.66, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1046.77, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2438.42, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2921.88, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2369.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 618.95, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL Q4180) REVITA, PER SQ CM", "code_information": [ { "code": "Q4180", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 126.52, "maximum": 2214.801, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2214.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INTRAPULMONARY SURFACTANT ADMINISTJ PHYS/QHP", "code_information": [ { "code": "94610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 134.38, "discounted_cash": 216.0, "minimum": 40.314, "maximum": 134.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 134.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 134.38, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 134.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 134.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 134.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 134.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 134.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 134.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 134.38, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 134.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 134.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 134.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 134.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 134.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 134.38, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Levofloxacin in D5W IV Soln 500 MG/100ML", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "25021013282", "type": "NDC" }, { "code": "J1956", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2.2145, "maximum": 2.2145, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2.21 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 21.73, "10th_percentile": 21.73, "90th_percentile": 21.73, "count": "1 through 10" } ] } ] }, { "description": "Pneumococcal 20-Valent Conjugate Vaccine Sus Pref Syr 0.5 ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00005200001", "type": "NDC" }, { "code": "90677", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 304.0762, "maximum": 672.735, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1158.7, "10th_percentile": 1158.7, "90th_percentile": 1158.7, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 380.08 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 304.08 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 672.74 } ] } ] }, { "description": "EXTRACRANIAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "039", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9988.0, "minimum": 7877.86, "maximum": 39936.3127, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9626.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 21241.1 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9626.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "other", "standard_charge_dollar": 33982.5, "standard_charge_algorithm": "74.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 30154.34, "10th_percentile": 30154.34, "90th_percentile": 30154.34, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9626.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 32184.74 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9988.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7877.86 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9988.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32184.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9626.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 9988.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9626.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13073.53 } ] } ] }, { "description": "HC HOME SLEEP TEST/TYPE 3 PORTA - 95806 - 74000034", "code_information": [ { "code": "95806", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1323.44, "discounted_cash": 213.0, "minimum": 213.05, "maximum": 1154.0397, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 677.54, "10th_percentile": 677.54, "90th_percentile": 806.6, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 839.33, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1019.59, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 815.7, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 677.54, "10th_percentile": 296.02, "90th_percentile": 798.53, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 923.23, "10th_percentile": 923.23, "90th_percentile": 923.23, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 360.31, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INJ, THERAP/PROPH/DIAGN, IV PUSH EA ADD NEW DX", "code_information": [ { "code": "96375", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 412.5, "discounted_cash": 46.0, "minimum": 46.2, "maximum": 359.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 264.0, "10th_percentile": 221.76, "90th_percentile": 887.04, "count": "19" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 182.01, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 221.1, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 176.89, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.3, "median_amount": 487.66, "10th_percentile": 487.66, "90th_percentile": 487.66, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 221.76, "10th_percentile": 138.38, "90th_percentile": 518.1, "count": "32" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50.36, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 575.52, "10th_percentile": 287.76, "90th_percentile": 580.8, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 78.13, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L4361) PNEUMA/VAC WALK BOOT PRE OTS", "code_information": [ { "code": "L4361", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 424.0, "minimum": 412.2764, "maximum": 717.4747, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 424.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 424.24, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 515.32, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 424.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 412.28, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 424.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 424.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 424.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 462.42, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 424.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 424.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 424.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 424.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 424.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 717.47, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L2270) VARUS/VALGUS STRAP PADDED/LI", "code_information": [ { "code": "L2270", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 72.0, "minimum": 70.1348, "maximum": 122.0539, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 72.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 72.17, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 87.66, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 72.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 70.13, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 72.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 72.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 72.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 78.67, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 72.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 72.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 72.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 72.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 72.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 122.05, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PERCUT AORTIC VALVULOPLASTY", "code_information": [ { "code": "92986", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22195.3, "discounted_cash": 5615.0, "minimum": 5615.88, "maximum": 22195.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 22124.32, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 22195.3, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 21501.52, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6121.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9497.58, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6234) HYDROCOLLD DRG <=16 W/O BDR - A6234 - RU272050", "code_information": [ { "code": "A6234", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 9.0, "minimum": 9.0669, "maximum": 15.7789, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.33, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.33, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9.07, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 9.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 9.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 9.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REPAIR BLOOD VESSEL DIRECT UPPER EXTREMITY", "code_information": [ { "code": "35206", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18439.7, "discounted_cash": 3115.0, "minimum": 3115.49, "maximum": 16079.4184, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12273.78, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14909.8, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11928.28, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5268.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC BFB TRAING W/EMG&/MANOMETRY EA ADDL 15 MIN CNTCT", "code_information": [ { "code": "90913", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 104.38, "discounted_cash": 20.0, "minimum": 19.8247, "maximum": 95.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 20.4, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.78, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 19.82, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 20.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 20.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.24, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 20.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY WITH C.D.E. WITH MCC", "code_information": [ { "code": "411", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 26170.0, "minimum": 18780.34, "maximum": 71440.03, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 25154.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 59690.1 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 25154.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 25154.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 71440.03 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 26170.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18780.34 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 26170.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 71440.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 25154.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 26170.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 25154.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 36738.25 } ] } ] }, { "description": "HC ASSAY OF URIC ACID, BLOOD, OTHER SOURCE", "code_information": [ { "code": "84560", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 154.69, "discounted_cash": 5.0, "minimum": 4.9367, "maximum": 134.8897, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.17, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.94, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.66 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.54, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.59, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "LACOSAMIDE IVPB 200 MG/100 ML (NS)", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "09999401301", "type": "NDC" }, { "code": "C9254", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "Cyclosporine Modified Oral Soln 100 MG/ML", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "00172731320", "type": "NDC" }, { "code": "J7502", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 4.343, "maximum": 4.343, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.34 } ] } ] }, { "description": "Lorazepam Inj 2 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "65219036801", "type": "NDC" }, { "code": "J2060", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 3.3755, "maximum": 3.3755, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 11.99, "10th_percentile": 11.99, "90th_percentile": 11.99, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.38 } ] } ] }, { "description": "HC IRRIGATION OF BLADDER", "code_information": [ { "code": "51700", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1116.56, "discounted_cash": 246.0, "minimum": 246.53, "maximum": 1116.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 971.23, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1116.56, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 943.89, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 268.72, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 416.93, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC", "code_information": [ { "code": "640", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11205.0, "minimum": 9191.53, "maximum": 30288.4514, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 27266.55, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 15515.53, "10th_percentile": 15515.53, "90th_percentile": 23451.65, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10794.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 24134.08 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10794.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10794.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 22589.14 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 11205.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9191.53 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11205.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22589.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10794.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 11205.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10794.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14854.12 } ] } ] }, { "description": "HC REPR WND SMP BODY/SCALP/EXTR >30.1 CM", "code_information": [ { "code": "12007", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 698.44, "discounted_cash": 197.0, "minimum": 197.97, "maximum": 698.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 215.79, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 334.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Ketorolac Tromethamine Inj 30 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00338007225", "type": "NDC" }, { "code": "J1885", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.3434, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 11.99, "10th_percentile": 11.99, "90th_percentile": 14.27, "count": "39" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.34, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.08 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 14.27, "10th_percentile": 14.13, "90th_percentile": 14.84, "count": "15" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 16.49, "10th_percentile": 16.49, "90th_percentile": 16.64, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MICROSLIDE CONSULT W SLIDE PREP", "code_information": [ { "code": "88323", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1474.38, "discounted_cash": 51.0, "minimum": 51.42, "maximum": 1285.6594, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 202.57, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 246.08, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 196.87, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 192.83 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.05, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Methylene Blue IV Soln 50 MG/10ML (5 MG/ML)", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "00143909401", "type": "NDC" }, { "code": "Q9968", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 10.0, "minimum": 10.287, "maximum": 49.2305, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 40.53, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 49.23, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 39.39, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.3 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 10.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 10.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.21, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 10.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.4, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CT GUIDANCE STEREOTACTIC LOCALIZATION", "code_information": [ { "code": "77011", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 992.5, "minimum": 297.75, "maximum": 992.5, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 992.5 } ] } ] }, { "description": "HC UNLISTED CT PROCEDURE", "code_information": [ { "code": "76497", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 335.0, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 335.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 335.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 335.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 335.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REVASC INTRA LITHOTRIP-ATHER", "code_information": [ { "code": "C9766", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 71019.1, "discounted_cash": 18087.0, "minimum": 18087.87, "maximum": 71019.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 71019.1, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 71019.1, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 69253.03, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19715.78, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30590.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT TARSAL FX W MANIP EA", "code_information": [ { "code": "28455", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 404.06, "discounted_cash": 1586.0, "minimum": 121.218, "maximum": 404.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Digoxin Inj 0.1 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "70515026310", "type": "NDC" }, { "code": "J1160", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 10.492, "maximum": 10.492, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.49 } ] } ] }, { "description": "HC (SUP SHELL A6216) NON-STERILE GAUZE<=16 SQ IN - A6216 - RU272046", "code_information": [ { "code": "A6216", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC EP EVAL TRANSVEN CARDIOVERTER", "code_information": [ { "code": "93642", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6438.44, "discounted_cash": 1201.0, "minimum": 1201.34, "maximum": 5749.2528, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4732.8, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5749.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4599.57, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1309.46, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2031.71, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6236) HYDROCOLLD DRG > 48 IN W/O B", "code_information": [ { "code": "A6236", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 38.0, "minimum": 37.735, "maximum": 65.6693, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 38.83, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 47.17, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 38.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 38.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.32, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 38.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 38.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 65.67, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC SUBDURAL TAP FONTANELLE/SUTUR INFANT UNI/BI INIT", "code_information": [ { "code": "61000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1049.06, "discounted_cash": 696.0, "minimum": 314.718, "maximum": 1049.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1049.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1049.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1049.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 759.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1049.06, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DUPLEX EXTREM VENOUS,UNI OR LTD", "code_information": [ { "code": "93971", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1617.19, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 1410.1897, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 706.1, "10th_percentile": 706.1, "90th_percentile": 706.1, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 832.19, "10th_percentile": 832.19, "90th_percentile": 832.19, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "KIDNEY AND URINARY TRACT NEOPLASMS WITHOUT CCMCC", "code_information": [ { "code": "688", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7058.0, "minimum": 5012.43, "maximum": 17090.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6815.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 14280.59 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6815.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6815.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 17090.9 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7058.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5012.43 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7058.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17090.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6815.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7058.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6815.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8789.46 } ] } ] }, { "description": "HC IMMUNOASSAY,INFECT AGENT,QUANT", "code_information": [ { "code": "86317", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 131.25, "discounted_cash": 14.0, "minimum": 14.5673, "maximum": 114.45, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.21, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 78.66 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.35, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF MERCURY", "code_information": [ { "code": "83825", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 292.81, "discounted_cash": 16.0, "minimum": 15.8015, "maximum": 255.3303, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.5, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 72.68, "10th_percentile": 72.68, "90th_percentile": 72.68, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.75, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 15.8, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 160.6, "10th_percentile": 160.6, "90th_percentile": 160.6, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 85.32 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.72, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 206.14, "10th_percentile": 206.14, "90th_percentile": 206.14, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC HEART IMAGE, SPECT", "code_information": [ { "code": "78494", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1286.56, "discounted_cash": 394.0, "minimum": 385.968, "maximum": 1286.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1286.56, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1286.56, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1286.56, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1286.56 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "PROSTATECTOMY WITH MCC", "code_information": [ { "code": "665", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24785.0, "minimum": 23765.08, "maximum": 67500.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 23825.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 56399.58 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 23825.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 23825.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 67500.47 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 24785.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23765.08 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24785.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 67500.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 23825.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 24785.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 23825.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34712.99 } ] } ] }, { "description": "HC HEPATITIS B SURFACE AB TEST", "code_information": [ { "code": "86706", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 136.56, "discounted_cash": 10.0, "minimum": 10.4371, "maximum": 119.0803, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 82.4, "10th_percentile": 69.22, "90th_percentile": 82.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.05, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 10.44, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 65.61, "10th_percentile": 65.61, "90th_percentile": 65.61, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 73.49, "10th_percentile": 70.62, "90th_percentile": 73.49, "count": "20" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 56.35 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 48.01, "10th_percentile": 48.01, "90th_percentile": 48.01, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.71, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 90.64, "10th_percentile": 56.35, "90th_percentile": 95.27, "count": "31" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.16, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "SEPTIC ARTHRITIS WITHOUT CCMCC", "code_information": [ { "code": "550", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7695.0, "minimum": 5966.88, "maximum": 25155.5694, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7426.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 15794.85 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7426.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7426.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 11933.63 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7695.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5966.88 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7695.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11933.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7426.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7695.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7426.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9721.46 } ] } ] }, { "description": "Perphenazine Tab 4 MG", "drug_information": { "unit": 100.0, "type": "EA" }, "code_information": [ { "code": "00904660061", "type": "NDC" }, { "code": "Q0175", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.2624, "maximum": 1.2624, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.26 } ] } ] }, { "description": "HC IMMUNE COMPLEX ASSAY", "code_information": [ { "code": "86332", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 347.19, "discounted_cash": 24.0, "minimum": 23.6828, "maximum": 302.7497, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 24.37, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 23.68, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 127.87 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 24.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 24.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.56, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 24.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REPLACE CV CATH CMPLT NONTUNNLD W SUBQ PORT/PUMP", "code_information": [ { "code": "36582", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8962.19, "discounted_cash": 3115.0, "minimum": 2688.657, "maximum": 8962.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8962.19, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8962.19, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8962.19, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5268.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT MCC", "code_information": [ { "code": "320", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19341.0, "minimum": 16021.49, "maximum": 52018.91, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18601.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 43463.39 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 18601.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 18601.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 52018.91 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 19341.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16021.49 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19341.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 52018.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18601.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 19341.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18601.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26750.98 } ] } ] }, { "description": "HC PROGRAM EVAL IMPLANTABLE IN PRSN 1 LD PACEMAKER", "code_information": [ { "code": "93279", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 208.44, "discounted_cash": 36.0, "minimum": 36.82, "maximum": 181.7597, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 145.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 176.21, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 140.97, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.27, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INTRA-ARTERIAL PARTICULATE ADMIN", "code_information": [ { "code": "79445", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 910.94, "discounted_cash": 230.0, "minimum": 230.23, "maximum": 910.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 907.01, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 910.94, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 881.48, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 769.27 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 250.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 389.36, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC LIPID PANEL", "code_information": [ { "code": "80061", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 247.5, "discounted_cash": 13.0, "minimum": 13.0124, "maximum": 215.82, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 143.4, "10th_percentile": 125.5, "90th_percentile": 149.4, "count": "257" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13.01, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 121.03, "10th_percentile": 34.09, "90th_percentile": 165.68, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 127.81, "10th_percentile": 122.89, "90th_percentile": 133.19, "count": "404" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70.26 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 59.85, "10th_percentile": 59.85, "90th_percentile": 143.4, "count": "126" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 157.74, "10th_percentile": 70.26, "90th_percentile": 165.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC THYROID MET IMAGING ADDN LTD", "code_information": [ { "code": "78016", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1523.44, "discounted_cash": 394.0, "minimum": 394.45, "maximum": 1523.44, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1523.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1523.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1510.23, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1523.44 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC BLOOD TYPING, PATIENT SERUM", "code_information": [ { "code": "86904", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 378.13, "discounted_cash": 58.0, "minimum": 58.2, "maximum": 329.7294, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 229.28, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 278.53, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 222.83, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 85.74 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.44, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 98.43, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MRI, LUMBAR SPINE", "code_information": [ { "code": "72148", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2668.44, "discounted_cash": 235.0, "minimum": 235.42, "maximum": 2326.8797, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 763.6, "10th_percentile": 670.95, "90th_percentile": 1707.8, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 927.46, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1126.65, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 901.35, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1628.17, "10th_percentile": 1628.17, "90th_percentile": 1659.55, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1114.42 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 491.66, "10th_percentile": 491.66, "90th_percentile": 491.66, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 256.61, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 1861.5, "10th_percentile": 1861.5, "90th_percentile": 1861.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Doxycycline Hyclate For Inj 100 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "68382091001", "type": "NDC" }, { "code": "J1271", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC MRI, CHEST", "code_information": [ { "code": "71550", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2893.44, "discounted_cash": 235.0, "minimum": 235.42, "maximum": 2523.0797, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 927.46, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1126.65, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 901.35, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2451.2 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 256.61, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "INFLAMMATORY BOWEL DISEASE WITHOUT CCMCC", "code_information": [ { "code": "387", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6229.0, "minimum": 4639.37, "maximum": 19254.4105, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6019.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 12310.98 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6019.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 16840.98, "standard_charge_algorithm": "76.27% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 20377.28, "10th_percentile": 20377.28, "90th_percentile": 20377.28, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6019.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 12284.33 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6229.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4639.37 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6229.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12284.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6019.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 6229.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6019.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7577.2 } ] } ] }, { "description": "HC HPV SEP HI-RSK TYP&POOL RSLT", "code_information": [ { "code": "87626", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 381.56, "discounted_cash": 70.0, "minimum": 68.2204, "maximum": 332.7203, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 70.2, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 85.27, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 68.22, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 70.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 70.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 76.52, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 70.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 70.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 118.72, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF AMYLASE", "code_information": [ { "code": "82150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 154.69, "discounted_cash": 6.0, "minimum": 6.2973, "maximum": 134.8897, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 99.0, "10th_percentile": 99.0, "90th_percentile": 99.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.87, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6.3, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 78.83, "10th_percentile": 78.83, "90th_percentile": 78.83, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 83.25, "10th_percentile": 83.25, "90th_percentile": 84.84, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.06, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 108.9, "10th_percentile": 107.91, "90th_percentile": 108.9, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.96, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MICRODISSECTION, MANUAL", "code_information": [ { "code": "88381", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 707.5, "minimum": 212.25, "maximum": 707.5, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 707.5 } ] } ] }, { "description": "CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC", "code_information": [ { "code": "074", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8887.0, "minimum": 7214.79, "maximum": 34523.4167, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8570.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 18626.39 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8570.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8570.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 16233.63 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8887.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7214.79 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8887.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16233.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 34523.42, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 16824.14, "10th_percentile": 16824.14, "90th_percentile": 16824.14, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8570.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8887.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8570.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11464.23 } ] } ] }, { "description": "HC MRI, CERV SPINE COMBO", "code_information": [ { "code": "72156", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3089.38, "discounted_cash": 344.0, "minimum": 344.22, "maximum": 2693.9394, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1660.85, "10th_percentile": 1660.85, "90th_percentile": 1660.85, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1356.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1647.33, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1317.92, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1921.34, "10th_percentile": 1921.34, "90th_percentile": 1921.34, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1945.18 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 855.6, "10th_percentile": 855.6, "90th_percentile": 855.6, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 2174.92, "10th_percentile": 2174.92, "90th_percentile": 2174.92, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REMVL PERM PM PLS GEN W/REPL PLSE GEN MULT LD SYS", "code_information": [ { "code": "33229", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 35935.9, "discounted_cash": 19005.0, "minimum": 10780.77, "maximum": 35935.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 35935.9, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 35935.9, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 35935.9, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20716.05, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32142.19, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC", "code_information": [ { "code": "438", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13446.0, "minimum": 11515.02, "maximum": 33195.93, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12944.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 29457.45 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12944.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12944.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 33195.93 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 13446.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11515.02 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13446.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 33195.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12944.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 13446.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12944.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18130.56 } ] } ] }, { "description": "HC INSJ OF SUBQ IMPLANTABLE DEFIBRILLATOR ELECTRODE", "code_information": [ { "code": "33271", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 24787.8, "discounted_cash": 8165.0, "minimum": 7436.34, "maximum": 24787.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 24787.8, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 24787.8, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 24787.8, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8900.22, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13809.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PERQ REPLACEMENT GTUBE REQ REVJ GSTRST TRC", "code_information": [ { "code": "43763", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1301.88, "discounted_cash": 246.0, "minimum": 246.53, "maximum": 1179.8186, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 971.23, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1179.82, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 943.89, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 268.72, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 416.93, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL Q4113) GRAFTJACKET XPRESS, INJECTABLE, 1 CC", "code_information": [ { "code": "Q4113", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1977.0325, "maximum": 1977.0325, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1977.03 } ] } ] }, { "description": "HC SUBDURAL TAP FONTANELLE/SUTUR INFANT UNI/BI SBSQ", "code_information": [ { "code": "61001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1049.06, "discounted_cash": 696.0, "minimum": 314.718, "maximum": 1049.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1049.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1049.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1049.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 759.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1049.06, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC", "code_information": [ { "code": "020", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 60893.0, "minimum": 55793.53, "maximum": 192604.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 58472.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 142187.96 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 58472.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 58472.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 192603.81 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 60893.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55793.53 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 60893.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 192604.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 58472.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 60893.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 58472.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 87514.28 } ] } ] }, { "description": "Dexamethasone Sod Phosphate Preservative Free Inj 10 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "63323050600", "type": "NDC" }, { "code": "J1100", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 11.99, "10th_percentile": 11.99, "90th_percentile": 12.71, "count": "40" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 14.84, "10th_percentile": 4.45, "90th_percentile": 14.84, "count": "24" } ] } ] }, { "description": "HC RADIOLOGIC EXAM ESOPHAGUS DOUBLE CONTRAST STUDY", "code_information": [ { "code": "74221", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1179.69, "discounted_cash": 173.0, "minimum": 173.07, "maximum": 1028.6897, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 296.63, "10th_percentile": 296.63, "90th_percentile": 296.63, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 681.83, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 828.26, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 662.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 598.34, "10th_percentile": 598.34, "90th_percentile": 598.34, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 692.08, "10th_percentile": 692.08, "90th_percentile": 692.08, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 675.69 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 712.2, "10th_percentile": 712.2, "90th_percentile": 712.2, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 292.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL Q4108) INTEGRA MATRIX, PER SQUARE CENTIMETER", "code_information": [ { "code": "Q4108", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 108.532, "maximum": 605.4868, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 108.53 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC AG DETECT NOS, EIA, MULT STEP", "code_information": [ { "code": "87449", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 369.06, "discounted_cash": 11.0, "minimum": 11.6422, "maximum": 321.8203, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 53.55, "10th_percentile": 53.55, "90th_percentile": 53.55, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.55, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.64, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 62.86 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.06, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.26, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC XRAY SPINE, COMPLETE, 2-3 VW", "code_information": [ { "code": "72082", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 714.06, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 622.6603, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 218.76, "10th_percentile": 218.76, "90th_percentile": 218.76, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 485.55 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC NM NUCLEAR DIAGNOSTIC EXAM UNLISTED", "code_information": [ { "code": "78999", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1130.63, "discounted_cash": 394.0, "minimum": 339.189, "maximum": 1130.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1130.63, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1130.63, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1130.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY SACROILIAC JTS <3 VW", "code_information": [ { "code": "72200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 549.06, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 493.645, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 278.48, "10th_percentile": 278.48, "90th_percentile": 278.48, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 222.3 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 99.95, "10th_percentile": 99.95, "90th_percentile": 99.95, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MRA SPINAL CANAL W CONTRAST - 72159 - 61800010", "code_information": [ { "code": "72159", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2284.38, "minimum": 685.314, "maximum": 2284.38, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2284.38 } ] } ] }, { "description": "HC ARTHROGRAM OF WRIST", "code_information": [ { "code": "73115", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1090.63, "discounted_cash": 344.0, "minimum": 327.189, "maximum": 1090.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1090.63, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1090.63, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1090.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 950.63 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INTERPRETATION OF FNA SMEAR", "code_information": [ { "code": "88173", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 176.56, "discounted_cash": 51.0, "minimum": 51.42, "maximum": 176.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 141.25, "10th_percentile": 141.25, "90th_percentile": 141.25, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 176.56, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 176.56, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 176.56, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 96.84, "10th_percentile": 96.84, "90th_percentile": 285.06, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 176.56 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 28.51, "10th_percentile": 28.51, "90th_percentile": 141.25, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.05, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 124.3, "10th_percentile": 124.3, "90th_percentile": 248.6, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC IMMUNIZ ADMIN, INJ, EA AD VAC", "code_information": [ { "code": "90472", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25.31, "minimum": 7.593, "maximum": 22.0703, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 48.11, "10th_percentile": 48.11, "90th_percentile": 48.11, "count": "1 through 10" } ] } ] }, { "description": "GASTROINTESTINAL OBSTRUCTION WITH MCC", "code_information": [ { "code": "388", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12279.0, "minimum": 10173.66, "maximum": 26685.5397, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11825.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 26685.54 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11825.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11825.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 17001.28 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12279.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10173.66 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12279.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17001.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11825.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 12279.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11825.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16424.5 } ] } ] }, { "description": "HC US, HEAD/NECK TISSUES,REAL TIME", "code_information": [ { "code": "76536", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1069.38, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 932.4994, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 645.6, "10th_percentile": 645.6, "90th_percentile": 645.6, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 511.64, "10th_percentile": 511.64, "90th_percentile": 1023.28, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 627.36, "10th_percentile": 627.36, "90th_percentile": 652.49, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 737.11 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 326.62, "10th_percentile": 326.62, "90th_percentile": 645.6, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 710.16, "10th_percentile": 655.83, "90th_percentile": 746.0, "count": "13" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Prothrombin Complex Concentrate Human-lans For Inj 1000 Unit", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "68982026102", "type": "NDC" }, { "code": "J7165", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 1.0, "minimum": 1.715, "maximum": 6.9015, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.76, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.83, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.9 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.87, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2.9, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC", "code_information": [ { "code": "897", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7762.0, "minimum": 6106.0, "maximum": 21956.2665, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 15952.05 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 19264.61, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 18375.29, "10th_percentile": 18375.29, "90th_percentile": 18375.29, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7762.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6106.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7762.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7762.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9818.22 } ] } ] }, { "description": "HC APPLY FINGER SPLINT STATIC", "code_information": [ { "code": "29130", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 580.0, "discounted_cash": 131.0, "minimum": 131.27, "maximum": 580.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 517.15, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 580.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 502.59, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.08, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 222.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC BLD CLOT FACTOR VIII, VW FC, RISTOCETIN COFACTR", "code_information": [ { "code": "85245", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 391.88, "discounted_cash": 22.0, "minimum": 22.2931, "maximum": 341.7194, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 27.87, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 22.29, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 120.37 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.8, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC TCAT INSJ PERM DUAL CHAMBER LDLS PM COMPL SYS", "code_information": [ { "code": "0795T", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 71516.9, "discounted_cash": 19005.0, "minimum": 19005.55, "maximum": 71516.9, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 71516.9, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 71516.9, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20716.05, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32142.19, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 71516.9, "additional_payer_notes": "393.96% of Medicare Rates" } ] } ] }, { "description": "Rifampin For Inj 600 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00068059701", "type": "NDC" }, { "code": "J2804", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC CT ORBIT/SELLA/POST FOSSA/EAR W/O CONTR", "code_information": [ { "code": "70480", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2150.63, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 1875.3494, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 399.22, "10th_percentile": 399.22, "90th_percentile": 399.22, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.9 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4619) FACE TENT", "code_information": [ { "code": "A4619", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 2.0, "minimum": 2.4975, "maximum": 4.3464, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2.57, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.12, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.8, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CARDIAC MRI W/W/O CONTRAST & FURTHER SEQ", "code_information": [ { "code": "75561", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2068.13, "discounted_cash": 344.0, "minimum": 344.22, "maximum": 2068.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1111.82, "10th_percentile": 1111.82, "90th_percentile": 1111.82, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1356.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1647.33, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1317.92, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2068.13 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 966.5, "10th_percentile": 966.5, "90th_percentile": 966.5, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC NJX AA&/STRD TFRML EPI LUMBAR/SACRAL 1 LEVEL", "code_information": [ { "code": "64483", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3680.94, "discounted_cash": 872.0, "minimum": 872.7, "maximum": 3680.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1995.15, "10th_percentile": 815.75, "90th_percentile": 2992.72, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3438.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3680.94, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3341.31, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 951.24, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1475.91, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "URETHRAL STRICTURE", "code_information": [ { "code": "697", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9245.0, "minimum": 6733.07, "maximum": 23310.02, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8913.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 19475.67 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8913.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8913.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 23310.02 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9245.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6733.07 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9245.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23310.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8913.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 9245.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8913.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11986.95 } ] } ] }, { "description": "HC ASSAY OF BLOOD PKU", "code_information": [ { "code": "84030", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 391.25, "discounted_cash": 5.0, "minimum": 5.3449, "maximum": 341.17, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.34, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.86 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC BUNDLE OF HIS RECORDING", "code_information": [ { "code": "93600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3523.13, "discounted_cash": 7695.0, "minimum": 1056.939, "maximum": 3523.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC BRAF GENE", "code_information": [ { "code": "81210", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1315.0, "discounted_cash": 175.0, "minimum": 170.4537, "maximum": 1146.68, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 175.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 175.4, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 213.06, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 175.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 170.45, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 920.36 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 175.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 175.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 175.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 191.19, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 175.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 175.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 175.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 175.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 175.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 296.64, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITHOUT MCC", "code_information": [ { "code": "324", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 25012.0, "minimum": 22114.34, "maximum": 110733.4719, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24043.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 56938.07 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 24043.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24043.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 80460.87 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 25012.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22114.34 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 25012.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 80460.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 110733.47, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 103056.12, "10th_percentile": 103056.12, "90th_percentile": 103056.12, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24043.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 25012.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 24043.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 35044.41 } ] } ] }, { "description": "HC REMV EXT CANAL FOREIGN BODY", "code_information": [ { "code": "69200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 344.69, "discounted_cash": 131.0, "minimum": 103.407, "maximum": 344.69, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.08, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 222.0, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 344.69, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 344.69, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 344.69, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF BENZODIAZEPINES - G0480 - 30100410", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 352.81, "discounted_cash": 114.0, "minimum": 34.218, "maximum": 1015.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 254.02, "10th_percentile": 72.91, "90th_percentile": 807.41, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 139.0, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 111.2, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 156.38, "10th_percentile": 156.38, "90th_percentile": 171.03, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 823.75, "10th_percentile": 177.26, "90th_percentile": 856.52, "count": "28" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 352.81 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 206.85, "10th_percentile": 206.85, "90th_percentile": 470.25, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 124.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 229.77, "10th_percentile": 218.68, "90th_percentile": 917.78, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 193.52, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6232) HYDROGEL DSG>16<=48 SQ IN", "code_information": [ { "code": "A6232", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 9.0, "minimum": 9.5042, "maximum": 16.5399, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.78, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.88, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9.5, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 9.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 9.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.66, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 9.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.54, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC TOXOPLASMA, IGM", "code_information": [ { "code": "86778", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 170.63, "discounted_cash": 14.0, "minimum": 14.0036, "maximum": 148.7894, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 64.41, "10th_percentile": 64.41, "90th_percentile": 64.41, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.41, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.5, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.0, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 75.61 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 14.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.71, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 14.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.37, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Remdesivir for IV Soln 100 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "61958290102", "type": "NDC" }, { "code": "J0248", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 6.0, "minimum": 6.5402, "maximum": 27.1754, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 27.18, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6.54, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.65 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 6.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 6.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.67, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC T CELL ABSOLUTE COUNT/RATIO", "code_information": [ { "code": "86360", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 160.94, "discounted_cash": 46.0, "minimum": 45.6552, "maximum": 160.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 46.98, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 57.07, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 45.66, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.94 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 46.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 46.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 51.21, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 46.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 112.27, "10th_percentile": 112.27, "90th_percentile": 112.27, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 46.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 79.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Epinephrine HCl-NaCl IV Soln 4 MG/250ML-0.9% (16 MCG/ML)", "drug_information": { "unit": 250.0, "type": "ML" }, "code_information": [ { "code": "42023031501", "type": "NDC" }, { "code": "J0171", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.5695, "maximum": 1.5695, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 11.99, "10th_percentile": 11.99, "90th_percentile": 11.99, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.57 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 14.6, "10th_percentile": 14.6, "90th_percentile": 14.6, "count": "1 through 10" } ] } ] }, { "description": "HC OLIGOCLONAL IMMUNOGLOBULIN", "code_information": [ { "code": "83916", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 218.75, "discounted_cash": 27.0, "minimum": 26.6176, "maximum": 190.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 27.39, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 33.27, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 26.62, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 143.72 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 27.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 27.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.86, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 27.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 27.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 46.32, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC OFFICE/OUTPATIENT ESTABLISHED SF MDM 10-19 MIN - G0463 - 76100007", "code_information": [ { "code": "G0463", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 221.25, "discounted_cash": 131.0, "minimum": 41.25, "maximum": 356.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 221.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 221.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 221.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.18, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 221.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "RED BLOOD CELL DISORDERS WITH MCC", "code_information": [ { "code": "811", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11728.0, "minimum": 9737.62, "maximum": 29579.7977, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11296.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 25375.48 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11296.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11296.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 23725.01 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 11728.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9737.62 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11728.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23725.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11296.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 11728.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11296.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15618.18 } ] } ] }, { "description": "MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CCMCC", "code_information": [ { "code": "060", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8043.0, "minimum": 6176.59, "maximum": 33976.9917, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7760.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 16620.64 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7760.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "other", "standard_charge_dollar": 28911.61, "standard_charge_algorithm": "74.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 9430.33, "10th_percentile": 9430.33, "90th_percentile": 9430.33, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7760.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 19645.18 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8043.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6176.59 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8043.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19645.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7760.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8043.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7760.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10229.72 } ] } ] }, { "description": "HC IV INFU, THERAP/PROPH/DIAGN, INIT, EA ADD HR", "code_information": [ { "code": "96366", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 405.0, "discounted_cash": 46.0, "minimum": 46.2, "maximum": 353.16, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 201.16, "10th_percentile": 201.16, "90th_percentile": 201.16, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50.36, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 225.5, "10th_percentile": 196.44, "90th_percentile": 892.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 78.13, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 256.61, "10th_percentile": 172.2, "90th_percentile": 769.82, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 182.01, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 221.1, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 176.89, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 196.44, "10th_percentile": 196.44, "90th_percentile": 196.44, "count": "32" } ] } ] }, { "description": "PULMONARY EMBOLISM WITHOUT MCC", "code_information": [ { "code": "176", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7170.0, "minimum": 5637.42, "maximum": 22878.5356, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 20595.93, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 19333.37, "10th_percentile": 19333.37, "90th_percentile": 19333.37, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6922.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 14546.22 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6922.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 20073.82, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 48454.85, "10th_percentile": 48454.85, "90th_percentile": 48454.85, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6922.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 12944.81 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7170.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5637.42 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7170.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12944.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6922.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7170.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6922.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8952.95 } ] } ] }, { "description": "MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC", "code_information": [ { "code": "372", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8813.0, "minimum": 7124.12, "maximum": 21848.6633, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8499.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 18449.31 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8499.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8499.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 15222.43 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8813.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7124.12 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8813.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15222.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8499.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8813.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8499.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11355.24 } ] } ] }, { "description": "HC (SUP SHELL A4364) ADHESIVE, LIQUID OR EQUAL", "code_information": [ { "code": "A4364", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 4.0, "minimum": 4.0718, "maximum": 7.0861, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.19, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.09, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.07, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 4.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.57, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC US BREAST UNILAT LIMITED", "code_information": [ { "code": "76642", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 612.19, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 533.8297, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 353.4, "10th_percentile": 296.86, "90th_percentile": 353.4, "count": "20" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 410.95, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 296.87, "10th_percentile": 296.87, "90th_percentile": 296.87, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 343.42, "10th_percentile": 343.42, "90th_percentile": 357.13, "count": "44" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 465.08 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 206.87, "10th_percentile": 132.89, "90th_percentile": 413.74, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 388.74, "10th_percentile": 338.65, "90th_percentile": 408.31, "count": "22" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4419) OST PCH FOR BAR W FLANGE/FLT", "code_information": [ { "code": "A4419", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 2.0, "minimum": 2.3906, "maximum": 4.1604, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2.46, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2.99, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2.39, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.68, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "INTERSTITIAL LUNG DISEASE WITH MCC", "code_information": [ { "code": "196", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15400.0, "minimum": 13040.48, "maximum": 34101.402, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14820.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 34101.4 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14820.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14820.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 28632.9 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 15400.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13040.48 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15400.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 28632.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14820.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 15400.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14820.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20988.83 } ] } ] }, { "description": "HC REM PAC CVDFB PLS GEN &REPL PLSE GEN MULTI LEAD", "code_information": [ { "code": "33264", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 118780.0, "discounted_cash": 30971.0, "minimum": 30971.47, "maximum": 118780.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30971.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 118780.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 118780.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30971.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 118580.47, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30971.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 30971.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 30971.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33758.9, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30971.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 30971.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30971.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 30971.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30971.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52378.95, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC NO PT PRSNT TRAIN INITIAL 30", "code_information": [ { "code": "G0541", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 338.13, "discounted_cash": 28.0, "minimum": 28.53, "maximum": 294.8494, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 112.4, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 136.54, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 109.23, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.1, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 48.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REVSC EVASC FPVT ST PLMT UNI CPLX LES 1ST VSL", "code_information": [ { "code": "37269", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 55875.3, "discounted_cash": 11390.0, "minimum": 11390.68, "maximum": 54512.3773, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 44874.72, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 54512.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 43611.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12415.84, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19263.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L1930) AFO PLASTIC/OTH MATERIAL PREFAB", "code_information": [ { "code": "L1930", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 313.0, "minimum": 304.8731, "maximum": 530.5633, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 313.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 313.72, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 381.08, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 313.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 304.87, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 313.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 313.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 313.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 341.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 313.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 313.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 313.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 313.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 313.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 530.56, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PERQ THRMBC/NFS DIAL CIRC TRLUML BALO ANGIOP S&I", "code_information": [ { "code": "36905", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 44757.5, "discounted_cash": 11390.0, "minimum": 11390.68, "maximum": 44757.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 44757.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 44757.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 43611.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12415.84, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19263.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "DIGESTIVE MALIGNANCY WITH MCC", "code_information": [ { "code": "374", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17313.0, "minimum": 14613.7, "maximum": 45569.7381, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16655.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 38645.97 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 16655.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 16655.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 38442.82 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 17313.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14613.7 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17313.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 38442.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16655.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 17313.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16655.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23785.94 } ] } ] }, { "description": "HC STRAPPING SHOULDER", "code_information": [ { "code": "29240", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 335.94, "discounted_cash": 131.0, "minimum": 100.782, "maximum": 335.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 335.94, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 335.94, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 335.94, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.08, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 222.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DRAIN FINGER ABSCESS,COMPLICATED", "code_information": [ { "code": "26011", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6264.69, "discounted_cash": 1629.0, "minimum": 1629.64, "maximum": 6264.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6264.69, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6264.69, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6239.4, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1776.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2756.05, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH CC", "code_information": [ { "code": "674", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18834.0, "minimum": 15977.2, "maximum": 97362.0128, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18114.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 42258.13 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 18114.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 18114.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 43913.79 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 18834.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15977.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18834.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 43913.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18114.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 18834.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18114.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26009.16 } ] } ] }, { "description": "KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITH MCC", "code_information": [ { "code": "695", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9747.0, "minimum": 7805.88, "maximum": 24736.21, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9395.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 20668.28 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9395.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9395.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 24736.21 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9747.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7805.88 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9747.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24736.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9395.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 9747.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9395.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12720.98 } ] } ] }, { "description": "HC CLOT INHIB PROTEIN S,TOTAL", "code_information": [ { "code": "85305", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 69.38, "discounted_cash": 11.0, "minimum": 11.2826, "maximum": 60.92, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.1, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.28, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 60.92 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4393) URINE PCH W EX WEAR BAR CONV", "code_information": [ { "code": "A4393", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 12.0, "minimum": 12.5168, "maximum": 21.7827, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.65, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.52, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.78, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT CLAVICLE FX WO MANIP", "code_information": [ { "code": "23500", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 487.5, "discounted_cash": 243.0, "minimum": 146.25, "maximum": 487.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 487.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 487.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 487.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 411.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Dornase Alfa Inhal Soln 2.5 MG/2.5ML", "drug_information": { "unit": 3.0, "type": "ML" }, "code_information": [ { "code": "50242010039", "type": "NDC" }, { "code": "J7639", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 115.2185, "maximum": 115.2185, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 115.22 } ] } ] }, { "description": "Enoxaparin Sodium Inj Soln Pref Syr 100 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00075062300", "type": "NDC" }, { "code": "J1650", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.118, "maximum": 1.118, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 35.37, "10th_percentile": 35.37, "90th_percentile": 35.37, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.12 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 41.68, "10th_percentile": 41.68, "90th_percentile": 43.54, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL A6447) CONFORM BAND S W >=5/YD", "code_information": [ { "code": "A6447", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.6405, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.18, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.06, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1.64, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC NM IDENTIFY SENTINEL NODE", "code_information": [ { "code": "38792", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1466.25, "discounted_cash": 394.0, "minimum": 394.45, "maximum": 1466.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1466.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1466.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1466.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4340) INDWELLING CATHETER SPECIAL - A4340 - RU278115", "code_information": [ { "code": "A4340", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 45.0, "minimum": 43.974, "maximum": 76.5268, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 45.25, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 54.97, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 43.97, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 45.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 45.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.32, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 45.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 45.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 76.53, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "PERITONEAL ADHESIOLYSIS WITHOUT CCMCC", "code_information": [ { "code": "337", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12722.0, "minimum": 10624.93, "maximum": 44408.4172, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12250.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 27737.2 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12250.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 38842.09, "standard_charge_algorithm": "76.27% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 38652.97, "10th_percentile": 38652.97, "90th_percentile": 38652.97, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12250.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 30029.87 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12722.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10624.93 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12722.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 30029.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12250.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 12722.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12250.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17071.78 } ] } ] }, { "description": "OTHER VASCULAR PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "254", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14598.0, "minimum": 12108.17, "maximum": 52983.6278, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14050.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 32195.03 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14050.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14050.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 36549.04 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14598.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12108.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14598.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 36549.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14050.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 14598.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14050.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19815.5 } ] } ] }, { "description": "INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH MCC", "code_information": [ { "code": "757", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11938.0, "minimum": 9795.76, "maximum": 115265.0322, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11497.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 25874.2 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11497.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11497.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 26622.21 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 11938.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9795.76 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11938.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26622.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11497.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 11938.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11497.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15925.13 } ] } ] }, { "description": "HC DRESS/DEBRIDE BURN >10% TTL LG", "code_information": [ { "code": "16030", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 838.44, "discounted_cash": 401.0, "minimum": 251.532, "maximum": 838.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 838.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 838.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 838.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 437.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 678.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4461) SURGICL DRESS HOLD NON-REUSE - A4461 - 27100058", "code_information": [ { "code": "A4461", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 4.0, "minimum": 4.5675, "maximum": 7.9486, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.7, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.71, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.57, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 4.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.95, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CESAREAN SECTION WITHOUT STERILIZATION WITH MCC", "code_information": [ { "code": "786", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13593.0, "minimum": 11184.18, "maximum": 29806.2011, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 25792.23, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 21480.93, "10th_percentile": 21480.93, "90th_percentile": 21480.93, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13085.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 29806.2 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13085.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 25138.39, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 23516.5, "10th_percentile": 23516.5, "90th_percentile": 23516.5, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13085.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 13593.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11184.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13593.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13085.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 13593.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13085.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18345.21 } ] } ] }, { "description": "KIDNEY AND URINARY TRACT INFECTIONS WITH MCC", "code_information": [ { "code": "689", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9872.0, "minimum": 8100.03, "maximum": 25461.4926, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9515.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 20966.44 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9515.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9515.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 20804.44 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9872.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8100.03 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9872.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20804.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9515.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 9872.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9515.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12904.49 } ] } ] }, { "description": "SPINAL DISORDERS AND INJURIES WITHOUT CCMCC", "code_information": [ { "code": "053", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8495.0, "minimum": 6377.31, "maximum": 17693.9873, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8193.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 17693.99 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8193.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8193.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 16660.31 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8495.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6377.31 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8495.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16660.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8193.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8495.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8193.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10890.35 } ] } ] }, { "description": "HC ARC RBC ANTIBODY SCREEN", "code_information": [ { "code": "86850", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 208.44, "discounted_cash": 51.0, "minimum": 51.2651, "maximum": 208.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 112.06, "10th_percentile": 112.06, "90th_percentile": 133.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 202.57, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 208.44, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 196.87, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 106.22, "10th_percentile": 106.22, "90th_percentile": 106.22, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 112.17, "10th_percentile": 112.17, "90th_percentile": 114.32, "count": "22" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 51.27 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 43.67, "10th_percentile": 43.67, "90th_percentile": 43.67, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.05, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 145.41, "10th_percentile": 51.27, "90th_percentile": 146.74, "count": "30" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REMOVE URETER STENT, PERCUT", "code_information": [ { "code": "50384", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11694.1, "discounted_cash": 2062.0, "minimum": 2062.58, "maximum": 10197.2552, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8125.74, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9870.89, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7897.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2248.21, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3488.24, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6550) NEG PRES WOUND THER DRSG SET", "code_information": [ { "code": "A6550", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 31.0, "minimum": 30.7769, "maximum": 53.5603, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 31.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 31.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.52, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 31.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 31.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53.56, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 31.67, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 38.47, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 30.78, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6410) STERILE EYE PAD - A6410 - 27200156", "code_information": [ { "code": "A6410", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PUNCH BIOPSY SKIN SINGLE LESION", "code_information": [ { "code": "11104", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1149.38, "discounted_cash": 401.0, "minimum": 344.814, "maximum": 1149.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1149.38, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1149.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1149.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 437.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 678.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CCMCC", "code_information": [ { "code": "829", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 25081.0, "minimum": 21344.0, "maximum": 78333.7103, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24108.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 57100.69 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 24108.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24108.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 47935.18 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 25081.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21344.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 25081.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 47935.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24108.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 25081.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 24108.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 35144.51 } ] } ] }, { "description": "HC (SUP SHELL A6258) TRANSPARENT FILM >16<=48 IN", "code_information": [ { "code": "A6258", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 6.0, "minimum": 5.9669, "maximum": 10.384, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.14, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.46, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.97, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 6.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.69, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 6.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.38, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MRI BRAIN CONTRAST", "code_information": [ { "code": "70552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2251.88, "discounted_cash": 344.0, "minimum": 344.22, "maximum": 1963.6394, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1356.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1647.33, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1317.92, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1708.21 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HEART FAILURE AND SHOCK WITH MCC", "code_information": [ { "code": "291", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10811.0, "minimum": 9030.95, "maximum": 28178.088, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 25366.74, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 36066.0, "10th_percentile": 19124.61, "90th_percentile": 44263.63, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10416.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 23198.06 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10416.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10416.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 19785.46 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 10811.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9030.95 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10811.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19785.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 28178.09, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 22181.08, "10th_percentile": 18699.88, "90th_percentile": 24981.88, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10416.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 10811.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10416.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14278.01 } ] } ] }, { "description": "HC (SUP SHELL A4434) OST PCH URINE W LOCK FLNG/FT", "code_information": [ { "code": "A4434", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 5.0, "minimum": 5.2088, "maximum": 9.0648, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.36, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.21, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.84, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.06, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L1810) KO ELASTIC WITH JOINTS", "code_information": [ { "code": "L1810", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 118.0, "minimum": 115.4401, "maximum": 200.8976, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 118.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 118.79, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 144.29, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 118.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 115.44, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 118.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 118.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 118.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 129.48, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 118.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 118.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 118.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 118.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 118.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 200.9, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ST EVAL SPEECH SOUND PROD LANGUAG COMPRHNS, 15 MIN", "code_information": [ { "code": "92523", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 903.44, "discounted_cash": 218.0, "minimum": 95.0, "maximum": 787.7997, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 218.5, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 265.41, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 212.34, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 554.06, "10th_percentile": 554.06, "90th_percentile": 554.06, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 218.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 218.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 238.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 218.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 218.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 369.53, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4623) TRACHEOSTOMY INNER CANNULA", "code_information": [ { "code": "A4623", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 9.0, "minimum": 9.0766, "maximum": 15.7958, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.35, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9.08, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.8, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Dextrose Inj 5% - 00264751010 - 25800000", "drug_information": { "unit": 500.0, "type": "ML" }, "code_information": [ { "code": "00264751010", "type": "NDC" }, { "code": "J7070", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 7.826, "maximum": 7.826, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.83 } ] } ] }, { "description": "HC WORK HARDENING EA ADD HR", "code_information": [ { "code": "97546", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 306.25, "minimum": 91.875, "maximum": 267.05, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS", "code_information": [ { "code": "029", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 26994.0, "minimum": 23232.83, "maximum": 61647.0661, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 25945.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 61647.07 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 25945.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 25945.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 51617.55 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 26994.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23232.83 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 26994.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 51617.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 25945.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 26994.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 25945.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 37942.72 } ] } ] }, { "description": "Phenylephrine HCl Inj 10 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "23155062031", "type": "NDC" }, { "code": "J2371", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 51.37, "10th_percentile": 11.99, "90th_percentile": 102.75, "count": "21" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 63.26, "10th_percentile": 51.37, "90th_percentile": 63.26, "count": "1 through 10" } ] } ] }, { "description": "HC X-RAY FOOT 3+ VW", "code_information": [ { "code": "73630", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 490.63, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 427.8294, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 296.2, "10th_percentile": 248.81, "90th_percentile": 296.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 410.95, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 248.85, "10th_percentile": 234.74, "90th_percentile": 248.85, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 299.36, "10th_percentile": 287.83, "90th_percentile": 299.36, "count": "11" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 231.09 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 102.59, "10th_percentile": 102.59, "90th_percentile": 296.2, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 325.82, "10th_percentile": 325.82, "90th_percentile": 325.82, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC US EXTREMITY NON VASCULAR REAL TIME COMP", "code_information": [ { "code": "76881", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 668.75, "discounted_cash": 103.0, "minimum": 96.5576, "maximum": 583.15, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 403.8, "10th_percentile": 403.8, "90th_percentile": 403.8, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 96.56 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 41.88, "10th_percentile": 41.88, "90th_percentile": 41.88, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L8420) PROSTHETIC SOCK MULTI PLY BK", "code_information": [ { "code": "L8420", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 25.0, "minimum": 24.7323, "maximum": 43.041, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 30.91, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 24.73, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.74, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.04, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC NEEDLE BIOPSY, LYMPH NODE(S)", "code_information": [ { "code": "38505", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3141.25, "discounted_cash": 1629.0, "minimum": 942.375, "maximum": 3141.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1972.71, "10th_percentile": 1972.71, "90th_percentile": 1972.71, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3141.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3141.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3141.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1776.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2756.05, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INSRT SINGLE TRANSVEN ELECTROD/PM/DEFIB", "code_information": [ { "code": "33216", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16404.7, "discounted_cash": 8165.0, "minimum": 4921.41, "maximum": 16404.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16404.7, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16404.7, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 16404.7, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8900.22, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13809.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MED NUTR THER, GROUP, EA 30 MIN", "code_information": [ { "code": "97804", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 61.25, "discounted_cash": 11.0, "minimum": 11.6033, "maximum": 53.41, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.94, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.5, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.6, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.01, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.19, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC HSV, DNA, AMP PROBE", "code_information": [ { "code": "87529", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 332.81, "discounted_cash": 35.0, "minimum": 34.1005, "maximum": 290.2103, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 42.62, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 34.1, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 184.12 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 232.17, "10th_percentile": 232.17, "90th_percentile": 232.17, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 59.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20-29 MIN - G0463 - 76100008", "code_information": [ { "code": "G0463", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 254.06, "discounted_cash": 131.0, "minimum": 41.25, "maximum": 356.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 254.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 254.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 254.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.18, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 222.16, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L8642) HALLUX IMPLANT", "code_information": [ { "code": "L8642", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 347.0, "minimum": 337.788, "maximum": 587.8442, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 347.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 347.59, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 422.22, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 347.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 337.79, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 347.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 347.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 347.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 378.87, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 347.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 347.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 347.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 347.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 347.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 587.84, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "URETHRAL PROCEDURES WITH CCMCC", "code_information": [ { "code": "671", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14699.0, "minimum": 11930.3, "maximum": 38818.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14147.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 32435.36 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14147.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14147.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 38818.86 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14699.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11930.3 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14699.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 38818.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14147.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 14699.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14147.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19963.42 } ] } ] }, { "description": "HC ANGIO PELVIS", "code_information": [ { "code": "75736", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8203.44, "discounted_cash": 5490.0, "minimum": 810.22, "maximum": 8203.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8203.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8203.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8203.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 810.22 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5984.62, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8203.44, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "INTRAOCULAR PROCEDURES WITH CCMCC", "code_information": [ { "code": "116", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14799.0, "minimum": 11548.93, "maximum": 40182.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14243.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 32672.08 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14243.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14243.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 40182.7 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14799.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11548.93 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14799.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 40182.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14243.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 14799.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14243.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20109.11 } ] } ] }, { "description": "HC (SUP SHELL A4404) OSTOMY RING EACH", "code_information": [ { "code": "A4404", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 2.0, "minimum": 1.9728, "maximum": 3.4331, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2.03, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2.47, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.97, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.21, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3.43, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION", "code_information": [ { "code": "880", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8350.0, "minimum": 6634.79, "maximum": 26600.203, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8055.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 17350.66 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8055.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8055.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 13126.01 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8350.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6634.79 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8350.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13126.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8055.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8350.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8055.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10679.04 } ] } ] }, { "description": "Hydromorphone HCl Inj 2 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "63323085303", "type": "NDC" }, { "code": "J1171", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 23.98, "10th_percentile": 11.99, "90th_percentile": 39.11, "count": "19" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 14.84, "10th_percentile": 11.99, "90th_percentile": 44.53, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 16.49, "10th_percentile": 16.49, "90th_percentile": 16.49, "count": "1 through 10" } ] } ] }, { "description": "HC REVSC EVASC IVT STENT SF 1ST", "code_information": [ { "code": "37258", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 55875.3, "discounted_cash": 11390.0, "minimum": 11390.68, "maximum": 54512.3773, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 44874.72, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 54512.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 43611.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12415.84, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19263.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY CLAVICLE", "code_information": [ { "code": "73000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 417.5, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 410.9481, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 97.31, "10th_percentile": 97.31, "90th_percentile": 97.31, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 410.95, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 211.76, "10th_percentile": 211.76, "90th_percentile": 211.76, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 216.42 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 277.2, "10th_percentile": 277.2, "90th_percentile": 291.25, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L8603) COLLAGEN IMP URINARY 2.5 ML", "code_information": [ { "code": "L8603", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 536.0, "minimum": 520.9723, "maximum": 906.6354, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 536.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 536.09, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 651.19, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 536.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 520.97, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 536.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 536.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 536.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 584.34, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 536.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 536.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 536.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 536.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 536.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 906.64, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH MCC", "code_information": [ { "code": "867", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16967.0, "minimum": 14841.41, "maximum": 45511.1842, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16323.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 37823.79 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 16323.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 16323.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 39181.25 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 16967.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14841.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16967.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 39181.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16323.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 16967.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16323.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23279.9 } ] } ] }, { "description": "HC X-RAY RIBS 2 VW UNILAT", "code_information": [ { "code": "71100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 533.44, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 465.1597, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 322.0, "10th_percentile": 322.0, "90th_percentile": 322.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 410.95, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 270.56, "10th_percentile": 270.56, "90th_percentile": 270.56, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 231.09 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT PROX HUMERUS FX W MANIP", "code_information": [ { "code": "23605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 878.75, "discounted_cash": 1586.0, "minimum": 263.625, "maximum": 878.75, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "109.00% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6219) GAUZE <= 16 SQ IN W/BORDER - A6219 - 27200123", "code_information": [ { "code": "A6219", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 1.0, "minimum": 1.3216, "maximum": 2.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.36, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.65, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.32, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.48, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2.3, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4388) DRAINABLE PCH W EX WEAR BARR", "code_information": [ { "code": "A4388", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 6.0, "minimum": 6.0349, "maximum": 10.5024, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.21, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.54, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 6.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.77, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 6.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ESCHAROTOMY", "code_information": [ { "code": "16035", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 719.69, "discounted_cash": 401.0, "minimum": 215.907, "maximum": 719.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 719.69, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 719.69, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 719.69, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 437.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 678.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Dronabinol Cap 2.5 MG", "drug_information": { "unit": 60.0, "type": "EA" }, "code_information": [ { "code": "67877075360", "type": "NDC" }, { "code": "Q0167", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 3.8924, "maximum": 3.8924, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.89 } ] } ] }, { "description": "HC REMOVE FB PHARYNX", "code_information": [ { "code": "42809", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 325.94, "discounted_cash": 440.0, "minimum": 97.782, "maximum": 325.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 325.94, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 325.94, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 325.94, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 325.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 325.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 325.94, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 325.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 325.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 325.94, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DRAINAGE OF EYELID ABSCESS", "code_information": [ { "code": "67700", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 518.13, "discounted_cash": 313.0, "minimum": 155.439, "maximum": 518.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 313.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 518.13, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 518.13, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 313.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 518.13, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 313.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 313.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 313.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 341.37, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 313.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 313.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 313.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 313.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 313.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 518.13, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY OPTIC FORAMEN", "code_information": [ { "code": "70190", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 868.44, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 757.2797, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 410.95, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 236.9 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC COLORECTAL CANCER SCREEN, SIGMOID, BA ENEMA - G0106 - 32000239", "code_information": [ { "code": "G0106", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 401.56, "discounted_cash": 169.0, "minimum": 120.468, "maximum": 401.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 169.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 401.56, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 401.56, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 169.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 401.56, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 169.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 169.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 169.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 184.29, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 169.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 169.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 169.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 169.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 169.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 285.93, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Ganciclovir Sodium IV Soln 500 MG/10ML (50 MG/ML) (Base Eq)", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "25021018510", "type": "NDC" }, { "code": "J1570", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 68.9935, "maximum": 68.9935, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 68.99 } ] } ] }, { "description": "HC REPAIR LIP,<1/2 VERT HEIGHT", "code_information": [ { "code": "40652", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4016.56, "discounted_cash": 532.0, "minimum": 532.15, "maximum": 3502.4403, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2096.46, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2546.71, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2037.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 580.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 899.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INJECT PERCUT CHOLANGIO W IMG", "code_information": [ { "code": "47531", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1950.63, "discounted_cash": 3532.0, "minimum": 585.189, "maximum": 1950.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1950.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1950.63, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1950.63, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1950.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1950.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1950.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1950.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1950.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1950.63, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1950.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1950.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1950.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1950.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1950.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1950.63, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLOSTRIDIUM TOXIN A W/OPTIC", "code_information": [ { "code": "87803", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 92.5, "discounted_cash": 16.0, "minimum": 15.5488, "maximum": 83.9552, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.44, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 15.55, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 83.96 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.44, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 61.38, "10th_percentile": 61.38, "90th_percentile": 64.53, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.06, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY ORBITS", "code_information": [ { "code": "70200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 734.06, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 640.1003, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 304.2 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITHOUT MCC", "code_information": [ { "code": "251", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12414.0, "minimum": 10815.27, "maximum": 38763.7267, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11954.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 27005.38 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11954.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11954.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 35485.24 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12414.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10815.27 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12414.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 35485.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11954.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 12414.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11954.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16621.35 } ] } ] }, { "description": "HC SHAVING SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.5CM/<", "code_information": [ { "code": "11300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 441.25, "discounted_cash": 401.0, "minimum": 132.375, "maximum": 441.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 441.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 441.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 441.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 437.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 441.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC I&D PERIRECTAL ABSCESS", "code_information": [ { "code": "46040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 524.69, "discounted_cash": 1180.0, "minimum": 157.407, "maximum": 524.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 524.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 524.69, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 524.69, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 524.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 524.69, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 524.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 524.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 524.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 524.69, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 524.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 524.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 524.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 524.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 524.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 524.69, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC NM IMAGING, WHOLE BODY, SINGLE DAY", "code_information": [ { "code": "78802", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6793.44, "discounted_cash": 535.0, "minimum": 535.74, "maximum": 5923.8797, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2110.6, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2563.89, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2051.19, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2149.91 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 583.96, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 906.04, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CYTOGENETICS DNA PROBE", "code_information": [ { "code": "88271", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1231.56, "discounted_cash": 21.0, "minimum": 20.816, "maximum": 1073.9203, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 21.42, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 26.02, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 20.82, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 112.4 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 21.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 21.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.35, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 21.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.23, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT WITH CCMCC", "code_information": [ { "code": "016", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 46145.0, "minimum": 41776.46, "maximum": 118791.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 44321.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 107148.73 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 44321.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 44321.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 118790.7 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 46145.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41776.46 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 46145.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 118791.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 44321.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 46145.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 44321.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 65948.23 } ] } ] }, { "description": "HC BARTONELLA DNA AMP PROBE", "code_information": [ { "code": "87471", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1521.56, "discounted_cash": 35.0, "minimum": 34.1005, "maximum": 1326.8003, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 42.62, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 34.1, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 184.12 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 59.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC URINARY BLADDER RESIDUAL STUDY", "code_information": [ { "code": "78730", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 212.81, "minimum": 63.843, "maximum": 212.81, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 212.81 } ] } ] }, { "description": "HC REPAIR FLEXOR TENDON LEG PRIMARY W/O GRAFT EACH", "code_information": [ { "code": "27658", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10935.9, "discounted_cash": 3228.0, "minimum": 3228.48, "maximum": 10935.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10935.9, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10935.9, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 10935.9, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3519.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5460.01, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PERQ CATH DRN W IMG PERI/RETRO", "code_information": [ { "code": "49406", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8025.0, "discounted_cash": 1629.0, "minimum": 1629.64, "maximum": 7798.9681, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6420.13, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7798.97, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6239.4, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1776.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2756.05, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC US GUIDE HEART BIOPSY", "code_information": [ { "code": "76932", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 860.31, "minimum": 258.093, "maximum": 750.1903, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 526.5 } ] } ] }, { "description": "Epoetin Alfa-epbx Inj 20000 Unit/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00069131101", "type": "NDC" }, { "code": "Q5106", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 7.0, "minimum": 7.6286, "maximum": 31.0559, "payers_information": [ { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.33, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 31.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.54, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.2 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 7.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.59, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 7.88, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC HEP C ANTIBODY, HIGH RISK - 86803 - 30200256", "code_information": [ { "code": "86803", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 264.06, "discounted_cash": 14.0, "minimum": 13.8676, "maximum": 230.2603, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 159.4, "10th_percentile": 63.79, "90th_percentile": 159.4, "count": "29" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.27, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.33, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 126.92, "10th_percentile": 37.89, "90th_percentile": 184.21, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 142.11, "10th_percentile": 136.61, "90th_percentile": 142.11, "count": "55" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 74.88 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 14.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 63.79, "10th_percentile": 63.79, "90th_percentile": 63.79, "count": "13" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.55, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 175.34, "10th_percentile": 175.34, "90th_percentile": 175.34, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 14.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.13, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT DIST FIBULA FX W MANIP", "code_information": [ { "code": "27788", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 597.19, "discounted_cash": 243.0, "minimum": 179.157, "maximum": 597.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 597.19, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 597.19, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 597.19, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 411.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MYELOGRAPHY LUMBAR INJ, CERVICAL", "code_information": [ { "code": "62302", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1503.13, "discounted_cash": 773.0, "minimum": 450.939, "maximum": 1503.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1503.13, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1503.13, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1503.13, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 843.1, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1308.13, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC SUGARS MONO DI&OLIGOS 1 QUALITATAIVE EACH SPEC", "code_information": [ { "code": "84376", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 39.38, "discounted_cash": 5.0, "minimum": 5.3449, "maximum": 34.3394, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.34, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.86 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF QUINIDINE", "code_information": [ { "code": "80194", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 143.75, "discounted_cash": 14.0, "minimum": 14.1883, "maximum": 125.35, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.73, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.19, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 76.61 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.69, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC VITAL CAPACITY, TOTAL", "code_information": [ { "code": "94150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 305.63, "discounted_cash": 126.0, "minimum": 91.689, "maximum": 305.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 305.63, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 305.63, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 305.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 138.38, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 214.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT STERN-CLAV DISLOC W MANIP", "code_information": [ { "code": "23525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 300.94, "discounted_cash": 243.0, "minimum": 90.282, "maximum": 300.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 300.94, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 300.94, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 300.94, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 300.94, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CT SCAN DORSAL SP COMBO", "code_information": [ { "code": "72130", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2169.38, "discounted_cash": 173.0, "minimum": 173.07, "maximum": 1891.6994, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 681.83, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 828.26, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 662.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1266.58 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 292.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Enoxaparin Sodium Inj Soln Pref Syr 30 MG/0.3ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "71288043280", "type": "NDC" }, { "code": "J1650", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.118, "maximum": 1.118, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 35.37, "10th_percentile": 35.37, "90th_percentile": 35.37, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.12 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 41.68, "10th_percentile": 41.68, "90th_percentile": 43.54, "count": "1 through 10" } ] } ] }, { "description": "HC REPTILASE TEST", "code_information": [ { "code": "85635", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 151.25, "discounted_cash": 9.0, "minimum": 9.5722, "maximum": 131.89, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.85, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.96, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9.57, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 51.68 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 9.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 9.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 9.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.66, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MRI CERV SPINE CONTRAST", "code_information": [ { "code": "72142", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2787.5, "discounted_cash": 344.0, "minimum": 344.22, "maximum": 2430.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1356.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1647.33, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1317.92, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1700.82, "10th_percentile": 1700.82, "90th_percentile": 1700.82, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1749.16 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ANGIOSCOPY NON-CORONARY VESSEL/GRAFTS THER IVNTJ", "code_information": [ { "code": "35400", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2717.81, "minimum": 815.343, "maximum": 2717.81, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 2717.81 } ] } ] }, { "description": "HC HISTOPLASMA", "code_information": [ { "code": "86698", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 136.25, "discounted_cash": 13.0, "minimum": 13.4011, "maximum": 118.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.79, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.75, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13.4, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 72.36 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 13.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.03, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.32, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC", "code_information": [ { "code": "574", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 27449.0, "minimum": 23981.72, "maximum": 75075.64, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 26381.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 62727.64 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 26381.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 26381.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 75075.64 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 27449.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23981.72 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 27449.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 75075.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 26381.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 27449.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 26381.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 38607.8 } ] } ] }, { "description": "HC IADNA MYCOPLASMA GENITALIUM AMPLIFIED PROBE TECH", "code_information": [ { "code": "87563", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 594.06, "discounted_cash": 35.0, "minimum": 34.1005, "maximum": 518.0203, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 156.85, "10th_percentile": 156.85, "90th_percentile": 156.85, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 42.62, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 34.1, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 184.12 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 414.42, "10th_percentile": 414.42, "90th_percentile": 414.42, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 59.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC NEUTRALIZATION TEST VIRAL", "code_information": [ { "code": "86382", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 339.69, "discounted_cash": 16.0, "minimum": 16.4331, "maximum": 296.2097, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.91, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.54, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 16.43, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 88.73 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 16.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 177.46, "10th_percentile": 177.46, "90th_percentile": 177.46, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 16.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC IMMUNOASSAY, TUMOR ANTIGEN, CA 125", "code_information": [ { "code": "86304", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 293.13, "discounted_cash": 20.0, "minimum": 20.2232, "maximum": 255.6094, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 177.0, "10th_percentile": 177.0, "90th_percentile": 177.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.28, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 20.22, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 109.19 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.68, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 194.7, "10th_percentile": 109.19, "90th_percentile": 204.48, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.19, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITHOUT CCMCC", "code_information": [ { "code": "437", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7537.0, "minimum": 5434.63, "maximum": 19653.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7275.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 15418.99 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7275.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7275.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 19652.97 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7537.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5434.63 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7537.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19653.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7275.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7537.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7275.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9490.13 } ] } ] }, { "description": "HC CLSD TREAT C-MC DISLOC W MANIP W ANES EA", "code_information": [ { "code": "26675", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2052.81, "discounted_cash": 1586.0, "minimum": 615.843, "maximum": 2052.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2052.81, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2052.81, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2052.81, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1729.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2052.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC", "code_information": [ { "code": "516", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16852.0, "minimum": 13923.64, "maximum": 91359.7016, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16213.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 37550.93 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 16213.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 16213.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 44644.42 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 16852.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13923.64 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16852.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 44644.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16213.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 16852.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16213.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23111.96 } ] } ] }, { "description": "HC RADIOLOGIC EXAM ABDOMEN 3+ VIEWS", "code_information": [ { "code": "74021", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 769.06, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 670.6203, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 266.15 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Prednisone Tab 2.5 MG", "drug_information": { "unit": 100.0, "type": "EA" }, "code_information": [ { "code": "64380083506", "type": "NDC" }, { "code": "J7512", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC (SUP SHELL A6443) CONFORM BAND N/S W>=3<5/YD", "code_information": [ { "code": "A6443", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Lidocaine IV Infusion in D5W Inj 4 MG/ML", "drug_information": { "unit": 500.0, "type": "ML" }, "code_information": [ { "code": "00338040903", "type": "NDC" }, { "code": "J2002", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC DENTAL SURGERY PROCEDURE", "code_information": [ { "code": "41899", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1014.38, "discounted_cash": 233.0, "minimum": 233.7, "maximum": 1014.38, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 920.68, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1014.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 894.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 254.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 395.23, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC REMOVE EYELID FB EMBEDDED", "code_information": [ { "code": "67938", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 520.94, "discounted_cash": 313.0, "minimum": 156.282, "maximum": 520.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 313.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 520.94, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 520.94, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 313.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 520.94, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 313.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 313.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 313.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 341.37, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 313.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 313.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 313.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 313.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 313.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 520.94, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Octreotide Acetate Inj 1000 MCG/ML (1 MG/ML)", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "63323037905", "type": "NDC" }, { "code": "J2354", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.2685, "maximum": 1.2685, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.27 } ] } ] }, { "description": "HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS", "code_information": [ { "code": "50437", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2084.69, "discounted_cash": 3478.0, "minimum": 625.407, "maximum": 2084.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2084.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2084.69, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2084.69, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2084.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2084.69, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2084.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2084.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2084.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2084.69, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2084.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2084.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2084.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2084.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2084.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2084.69, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC SURG PATH,LEVEL V", "code_information": [ { "code": "88307", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 774.06, "discounted_cash": 353.0, "minimum": 232.218, "maximum": 774.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 416.14, "10th_percentile": 416.14, "90th_percentile": 495.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 353.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 774.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 774.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 353.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 774.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 774.06 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 353.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 353.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 619.25, "10th_percentile": 416.14, "90th_percentile": 619.25, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 353.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 385.51, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 353.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 353.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 353.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 353.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 353.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 598.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ARTERIAL LINE INSERTION", "code_information": [ { "code": "36620", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2350.0, "minimum": 705.0, "maximum": 2049.2, "payers_information": [ { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1390.57, "10th_percentile": 1390.57, "90th_percentile": 1390.57, "count": "1 through 10" } ] } ] }, { "description": "Epoetin Alfa Inj 4000 Unit/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "59676030400", "type": "NDC" }, { "code": "J0885", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 7.0, "minimum": 7.305, "maximum": 28.7788, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 28.78, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.37, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8.3, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.22 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.96, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.35, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6266) IMPREG GAUZE NO H20/SAL/YARD - A6266 - 27200151", "code_information": [ { "code": "A6266", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 2.0, "minimum": 2.6433, "maximum": 4.6001, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2.72, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.3, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2.64, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.96, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ED LEVEL 1", "code_information": [ { "code": "99281", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 314.69, "discounted_cash": 83.0, "minimum": 83.2, "maximum": 314.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 175.2, "10th_percentile": 175.2, "90th_percentile": 175.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 83.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 314.69, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 314.69, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 83.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 314.69, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.3, "median_amount": 362.62, "10th_percentile": 362.62, "90th_percentile": 362.62, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 170.25, "10th_percentile": 170.25, "90th_percentile": 192.01, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 167.89, "10th_percentile": 167.89, "90th_percentile": 192.99, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 83.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 83.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 197.62, "10th_percentile": 173.45, "90th_percentile": 197.62, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 83.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 90.69, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 83.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 83.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 192.72, "10th_percentile": 192.72, "90th_percentile": 219.53, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 83.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 83.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 83.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 140.71, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CT SCAN OF LEG COMBO", "code_information": [ { "code": "73702", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2044.06, "discounted_cash": 173.0, "minimum": 173.07, "maximum": 1782.4203, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 681.83, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 828.26, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 662.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1272.41, "10th_percentile": 1272.41, "90th_percentile": 1272.41, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1260.7 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 292.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC RH IG, FULL-DOSE, IM - 90384 - 39000005", "code_information": [ { "code": "90384", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 512.81, "minimum": 153.843, "maximum": 447.1703, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 181.65 } ] } ] }, { "description": "HC REVSC EVASC TPVT ST ATHRC UNI CPLX LES 1ST VSL", "code_information": [ { "code": "37294", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 88727.2, "discounted_cash": 18087.0, "minimum": 18087.87, "maximum": 86563.1195, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 71258.97, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 86563.12, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 69253.03, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19715.78, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30590.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC", "code_information": [ { "code": "806", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6782.0, "minimum": 5008.27, "maximum": 13624.6594, "payers_information": [ { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 10411.97, "standard_charge_algorithm": "76.27% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 4715.4, "10th_percentile": 4715.4, "90th_percentile": 10683.35, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6550.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 9392.98 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "other", "standard_charge_dollar": 11876.77, "standard_charge_algorithm": "87% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 6759.57, "10th_percentile": 6759.57, "90th_percentile": 22647.75, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6782.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5008.27 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6782.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9392.98 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 11904.08, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 8460.63, "10th_percentile": 5878.57, "90th_percentile": 25584.97, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6550.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 6782.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6550.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8385.75 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 10716.4, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 13711.84, "10th_percentile": 13095.39, "90th_percentile": 20433.85, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6550.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 13624.66 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6550.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "other", "standard_charge_dollar": 10129.38, "standard_charge_algorithm": "74.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 5169.74, "10th_percentile": 4734.64, "90th_percentile": 13731.37, "count": "1 through 10" } ] } ] }, { "description": "HC US, OB >/= 14 WKS, ADD'L FETUS", "code_information": [ { "code": "76810", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1101.88, "minimum": 330.564, "maximum": 960.8394, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 362.71 } ] } ] }, { "description": "HC NM BRAIN IMAGING < 4 STATIC VIEWS W VASCULAR FLOW", "code_information": [ { "code": "78601", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1752.19, "discounted_cash": 394.0, "minimum": 394.45, "maximum": 1752.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1553.98, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1752.19, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1510.23, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1553.21 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REPAIR EXTEN LEG TENDON,PRIM,EA", "code_information": [ { "code": "28208", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6319.38, "discounted_cash": 3228.0, "minimum": 1895.814, "maximum": 6319.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6319.38, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6319.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6319.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3519.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5460.01, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "SIMPLE PNEUMONIA AND PLEURISY WITHOUT CCMCC", "code_information": [ { "code": "195", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5828.0, "minimum": 4309.91, "maximum": 13011.4299, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5634.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 11356.89 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 5634.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 5634.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 9728.09 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 5828.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4309.91 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5828.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9728.09 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5634.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 5828.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 5634.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6989.98 } ] } ] }, { "description": "URINARY STONES WITH MCC", "code_information": [ { "code": "693", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11273.0, "minimum": 10177.12, "maximum": 29077.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10859.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 24294.9 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10859.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10859.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 29077.12 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 11273.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10177.12 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11273.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 29077.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10859.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 11273.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10859.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14953.1 } ] } ] }, { "description": "HC TRANSCATH STENT, CCA W/EPS", "code_information": [ { "code": "37215", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10182.8, "minimum": 3054.84, "maximum": 10182.8, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 10182.8 } ] } ] }, { "description": "HC (SUP SHELL Q4106) DERMAGRAFT", "code_information": [ { "code": "Q4106", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 96.621, "maximum": 96.621, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 96.62 } ] } ] }, { "description": "HC ASSAY OF TOTAL TESTOSTERONE", "code_information": [ { "code": "84403", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 347.19, "discounted_cash": 25.0, "minimum": 25.0822, "maximum": 302.7497, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 222.2, "10th_percentile": 222.2, "90th_percentile": 222.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 31.35, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 25.08, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 176.93, "10th_percentile": 176.93, "90th_percentile": 176.93, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 190.43, "10th_percentile": 186.84, "90th_percentile": 190.43, "count": "21" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 135.43 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 115.37, "10th_percentile": 115.37, "90th_percentile": 222.2, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 135.43, "10th_percentile": 135.43, "90th_percentile": 135.43, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.65, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT MED MALLEOLUS FX W MANIP", "code_information": [ { "code": "27762", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 839.38, "discounted_cash": 1586.0, "minimum": 251.814, "maximum": 839.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 839.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 839.38, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 839.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 839.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 839.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 839.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 839.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 839.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 839.38, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 839.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 839.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 839.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 839.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 839.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 839.38, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC URINE BACT CULT ID", "code_information": [ { "code": "87088", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 183.13, "discounted_cash": 8.0, "minimum": 7.8619, "maximum": 159.6894, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 110.6, "10th_percentile": 92.9, "90th_percentile": 110.6, "count": "61" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.83, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7.86, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 88.07, "10th_percentile": 88.07, "90th_percentile": 88.07, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 98.55, "10th_percentile": 94.78, "90th_percentile": 98.55, "count": "89" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 42.45 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 36.16, "10th_percentile": 36.16, "90th_percentile": 110.6, "count": "25" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.82, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 42.45, "10th_percentile": 42.45, "90th_percentile": 127.75, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC SURG PATH,GROSS,LEVEL I", "code_information": [ { "code": "88300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 156.25, "discounted_cash": 28.0, "minimum": 28.53, "maximum": 136.536, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 84.0, "10th_percentile": 84.0, "90th_percentile": 84.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 112.4, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 136.54, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 109.23, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 77.97 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.1, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 48.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT HUMER EPICONDYLR FX W MANIP", "code_information": [ { "code": "24565", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3256.56, "discounted_cash": 1586.0, "minimum": 976.968, "maximum": 3256.56, "payers_information": [ { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2683.27, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3256.56, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3256.56, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3256.56, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1729.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC GASTROESOPHAGEAL REFLUX EXAM", "code_information": [ { "code": "78262", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1104.38, "discounted_cash": 394.0, "minimum": 331.314, "maximum": 1104.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1104.38, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1104.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1104.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1104.38 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC TWIST DRILL HOLE IMPLT VENTRICULAR CATH/DEVICE", "code_information": [ { "code": "61107", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3760.31, "minimum": 1128.093, "maximum": 3760.31, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 3760.31 } ] } ] }, { "description": "HC FETAL BIOPHYS PROF,W/O NST", "code_information": [ { "code": "76819", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 780.0, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 680.16, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 195.92, "10th_percentile": 195.92, "90th_percentile": 195.92, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 435.82 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 195.92, "10th_percentile": 195.92, "90th_percentile": 195.92, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 518.1, "10th_percentile": 451.34, "90th_percentile": 544.13, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC RTRVL INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I", "code_information": [ { "code": "37193", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11306.6, "discounted_cash": 3115.0, "minimum": 3115.49, "maximum": 11306.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11306.6, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 11306.6, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11306.6, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5268.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC", "code_information": [ { "code": "832", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6536.0, "minimum": 5173.0, "maximum": 13039.1965, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 7115.91, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 9547.62, "10th_percentile": 9547.62, "90th_percentile": 9547.62, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6314.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 13039.2 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6314.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6314.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 8707.17 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6536.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5173.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6536.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8707.17 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 7904.55, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 11524.48, "10th_percentile": 11524.48, "90th_percentile": 11524.48, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6314.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 6536.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6314.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8025.4 } ] } ] }, { "description": "HC CHOLECYSTOSTOMY,PERCUTANEOUS, COMPLETE", "code_information": [ { "code": "47490", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6640.31, "discounted_cash": 3532.0, "minimum": 1992.093, "maximum": 6640.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6640.31, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6640.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6640.31, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3850.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5974.64, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6252) ABSORPT DRG >16 <=48 W/O BDR - A6252 - RU272054", "code_information": [ { "code": "A6252", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 4.0, "minimum": 4.5092, "maximum": 7.8472, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.64, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.51, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.85, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY THORACIC SPINE+SWIM 3 VW", "code_information": [ { "code": "72072", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 580.94, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 506.5797, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 254.46 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6224) GAUZE > 48 IN NO W/SAL W/O B - A6224 - RU272049", "code_information": [ { "code": "A6224", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 5.0, "minimum": 4.9853, "maximum": 8.6759, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.13, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.23, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.99, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.59, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.68, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L2755) CARBON GRAPHITE LAMINATION", "code_information": [ { "code": "L2755", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 156.0, "minimum": 152.2616, "maximum": 264.9772, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 156.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 156.68, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 190.32, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 156.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 152.26, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 156.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 156.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 156.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 170.78, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 156.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 156.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 156.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 156.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 156.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 264.98, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "PREMATURITY WITHOUT MAJOR PROBLEMS", "code_information": [ { "code": "792", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19675.0, "minimum": 4315.59, "maximum": 44256.6521, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 25874.7, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 6551.56, "10th_percentile": 6551.56, "90th_percentile": 6551.56, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18921.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 44256.65 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 18921.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 25218.77, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 4232.92, "10th_percentile": 4232.92, "90th_percentile": 4232.92, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 18921.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 4315.59 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 19675.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16955.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19675.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4315.59 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 28742.34, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 73063.76, "10th_percentile": 73063.76, "90th_percentile": 73063.76, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18921.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 19675.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18921.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27239.22 } ] } ] }, { "description": "HC (SUP SHELL Q4040) CAST SUP SHRT LEG PED FBRGLS", "code_information": [ { "code": "Q4040", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 26.0, "minimum": 25.4903, "maximum": 44.3602, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 26.23, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 31.86, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 25.49, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 26.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 26.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.59, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 26.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 44.36, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC", "code_information": [ { "code": "485", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 25591.0, "minimum": 22281.84, "maximum": 139799.694, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24598.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 58313.18 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 24598.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24598.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 69791.73 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 25591.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22281.84 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 25591.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 69791.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24598.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 25591.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 24598.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 35890.77 } ] } ] }, { "description": "Zoledronic Acid IV Soln 5 MG/100ML", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "72266015201", "type": "NDC" }, { "code": "J3489", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 17.501, "maximum": 17.501, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.5 } ] } ] }, { "description": "HC LARYNGOSCOPY INDIRECT DIAGNOSTIC", "code_information": [ { "code": "31505", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 515.63, "discounted_cash": 196.0, "minimum": 154.689, "maximum": 515.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 515.63, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 515.63, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 515.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 214.68, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 333.08, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MRI BRAIN", "code_information": [ { "code": "70551", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2178.75, "discounted_cash": 235.0, "minimum": 235.42, "maximum": 1899.87, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1171.3, "10th_percentile": 513.69, "90th_percentile": 1171.3, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 927.46, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1126.65, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 901.35, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1329.39, "10th_percentile": 1329.39, "90th_percentile": 1355.01, "count": "14" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1161.24 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 514.09, "10th_percentile": 514.09, "90th_percentile": 1380.46, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 256.61, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 1140.23, "10th_percentile": 1140.23, "90th_percentile": 1140.23, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC", "code_information": [ { "code": "260", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 25786.0, "minimum": 23575.43, "maximum": 58777.5756, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24786.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 58777.58 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 24786.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24786.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 48741.79 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 25786.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23575.43 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 25786.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 48741.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24786.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 25786.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 24786.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 36176.6 } ] } ] }, { "description": "HC EXPLORE WOUND,CHEST", "code_information": [ { "code": "20101", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11248.1, "discounted_cash": 2035.0, "minimum": 2035.84, "maximum": 9808.3432, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8020.4, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9742.92, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7794.62, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2219.07, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2035.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3443.01, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DUPLEX SCAN ARTL INFL&VEN O/F HEMO COMPL UNI STD", "code_information": [ { "code": "93986", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 600.63, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 523.7494, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4322) IRRIGATION SYRINGE", "code_information": [ { "code": "A4322", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 4.0, "minimum": 4.2273, "maximum": 7.3567, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.28, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.36, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6456) ZINC PASTE BAND W >=3<5/YD - A6456 - RU272008", "code_information": [ { "code": "A6456", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 1.0, "minimum": 1.7395, "maximum": 3.0272, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.79, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2.17, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.74, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3.03, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REPAIR LIP,>1/2 VERT HEIGHT", "code_information": [ { "code": "40654", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3190.63, "discounted_cash": 1530.0, "minimum": 957.189, "maximum": 3190.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3190.63, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3190.63, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3190.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1668.74, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2589.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF C-PEPTIDE", "code_information": [ { "code": "84681", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 411.88, "discounted_cash": 20.0, "minimum": 20.2232, "maximum": 359.1594, "payers_information": [ { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.68, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 289.96, "10th_percentile": 289.96, "90th_percentile": 289.96, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.19, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.28, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 20.22, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 221.65, "10th_percentile": 221.65, "90th_percentile": 225.91, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 109.19 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC BIOFEEDBACK TRAIN ANY METH", "code_information": [ { "code": "90901", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 150.0, "discounted_cash": 16.0, "minimum": 15.5974, "maximum": 130.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.05, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.5, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 15.6, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 16.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.49, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 16.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PERQ BREAST LOC DEV PLACE MRI GUIDE 1ST LESION", "code_information": [ { "code": "19287", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2553.13, "discounted_cash": 698.0, "minimum": 698.71, "maximum": 2553.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2553.13, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2553.13, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2553.13, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 761.59, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1181.66, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Hydroxocobalamin (Antidote) For IV Soln 5 GM", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "50633031011", "type": "NDC" }, { "code": "J3424", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 5.0, "minimum": 5.0922, "maximum": 21.4432, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 21.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.37, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.09, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.94 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.93, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INSJ IMPLNTBL DEFIB PULSE GEN W/EXIST MULTILEADS", "code_information": [ { "code": "33231", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 118780.0, "discounted_cash": 30971.0, "minimum": 30971.47, "maximum": 118780.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30971.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 118780.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 118780.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30971.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 118580.47, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30971.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 30971.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 30971.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33758.9, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30971.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 30971.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30971.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 30971.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30971.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52378.95, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER VASCULAR PROCEDURES WITH CC", "code_information": [ { "code": "253", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20788.0, "minimum": 17670.16, "maximum": 71411.5539, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 19990.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 46902.08 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 19990.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 19990.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 51989.68 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 20788.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17670.16 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20788.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 51989.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 19990.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 20788.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 19990.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28867.43 } ] } ] }, { "description": "HC CLSD TREAT POST HIP ARTHRPLAS DISLOC W ANES", "code_information": [ { "code": "27265", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 465.94, "discounted_cash": 243.0, "minimum": 139.782, "maximum": 465.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 465.94, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 465.94, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 465.94, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 411.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC NEEDLE BIOPSY OF PANCREAS", "code_information": [ { "code": "48102", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1909.38, "discounted_cash": 1629.0, "minimum": 572.814, "maximum": 1909.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1909.38, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1909.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1909.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1776.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1909.38, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC FINE NEEDLE ASP WO IMG GUIDANCE", "code_information": [ { "code": "10021", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1638.44, "discounted_cash": 401.0, "minimum": 401.1, "maximum": 1638.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1580.17, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1638.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1535.69, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 437.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 678.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC", "code_information": [ { "code": "521", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22877.0, "minimum": 20173.6, "maximum": 84096.2019, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 21994.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 51864.05 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 21994.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 21994.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 62072.38 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 22877.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20173.6 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22877.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 62072.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 21994.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 22877.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 21994.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 31921.45 } ] } ] }, { "description": "HC (SUP SHELL A4618) BREATHING CIRCUITS", "code_information": [ { "code": "A4618", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 12.0, "minimum": 12.3224, "maximum": 21.4444, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.4, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.82, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.44, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC WORK HARDENING INIT 2 HR", "code_information": [ { "code": "97545", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 565.63, "minimum": 95.0, "maximum": 493.2294, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "Immune Globulin (Human) IV or Subcutaneous Soln 5 GM/50ML", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "44206043605", "type": "NDC" }, { "code": "J1561", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 49.0, "minimum": 47.5793, "maximum": 195.9005, "payers_information": [ { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 49.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 49.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 54.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 49.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 49.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 84.1, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 195.9, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 59.47, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 47.58, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 103.95 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.73, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Methylprednisolone Acetate Inj Susp 40 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00009307301", "type": "NDC" }, { "code": "J1010", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC GAS DILUT/WASHOUT LUNG VOL W/WO DISTRB VENT&VOL", "code_information": [ { "code": "94727", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 741.25, "discounted_cash": 213.0, "minimum": 213.05, "maximum": 741.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 741.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 741.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 741.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 360.31, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Prednisone Tab 5 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "60687012211", "type": "NDC" }, { "code": "J7512", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC NM PULMONARY VENTILATION & PERFUSION IMAGING", "code_information": [ { "code": "78582", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1826.56, "discounted_cash": 535.0, "minimum": 535.74, "maximum": 1826.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1826.56, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1826.56, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1826.56, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1826.56 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 583.96, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 906.04, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INTRAVASC US,HEART,1ST VESSEL", "code_information": [ { "code": "92978", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5687.5, "minimum": 1706.25, "maximum": 4959.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 3603.6, "10th_percentile": 3603.6, "90th_percentile": 3603.6, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 3967.6, "10th_percentile": 3967.6, "90th_percentile": 3967.6, "count": "1 through 10" } ] } ] }, { "description": "HC ACTINOTHERAPY ULTRAVIOLET LIGHT", "code_information": [ { "code": "96900", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 201.56, "discounted_cash": 36.0, "minimum": 36.85, "maximum": 176.353, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 145.17, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 176.35, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 141.09, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.32, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PROTEIN TOT REFRACTOMETRY ANY SRC", "code_information": [ { "code": "84160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 94.38, "discounted_cash": 5.0, "minimum": 5.4518, "maximum": 82.2994, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 21.5, "10th_percentile": 21.5, "90th_percentile": 25.6, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.61, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.81, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.45, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 20.38, "10th_percentile": 20.38, "90th_percentile": 20.38, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 21.94, "10th_percentile": 21.53, "90th_percentile": 21.94, "count": "17" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.44 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 25.08, "10th_percentile": 25.08, "90th_percentile": 25.08, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.11, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 28.16, "10th_percentile": 27.9, "90th_percentile": 29.44, "count": "16" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.49, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES", "code_information": [ { "code": "11976", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2328.75, "discounted_cash": 698.0, "minimum": 698.625, "maximum": 2328.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2328.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2328.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2328.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 761.59, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1181.66, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L2820) SOFT INTERFACE BELOW KNEE SE", "code_information": [ { "code": "L2820", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 132.0, "minimum": 128.7927, "maximum": 224.1347, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 132.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 132.53, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 160.98, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 132.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 128.79, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 132.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 132.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 132.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 144.46, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 132.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 132.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 132.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 132.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 132.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 224.13, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "810", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9007.0, "minimum": 6587.72, "maximum": 32735.3422, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8685.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 18911.89 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8685.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8685.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 11701.77 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9007.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6587.72 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9007.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11701.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8685.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 9007.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8685.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11639.95 } ] } ] }, { "description": "Ceftazidime-Avibactam Sodium For IV Soln 2.5 GM (2-0.5 GM)", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00456270001", "type": "NDC" }, { "code": "J0714", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 104.0, "minimum": 101.7766, "maximum": 412.6692, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 104.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 412.67, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 127.22, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 104.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 101.78, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 216.08 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 104.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 104.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 104.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 114.18, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 104.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 104.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 104.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 104.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 104.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 177.15, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "042", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14187.0, "minimum": 12164.93, "maximum": 33455.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13656.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 31219.26 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13656.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13656.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 33455.06 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14187.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12164.93 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14187.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 33455.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13656.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 14187.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13656.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19214.93 } ] } ] }, { "description": "HC (SUP SHELL A4628) OROPHARYNGEAL SUCTION CATH - A4628 - 27200093", "code_information": [ { "code": "A4628", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 5.0, "minimum": 5.1797, "maximum": 9.0141, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.01, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.33, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.81, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.33, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "INTERSTITIAL LUNG DISEASE WITH CC", "code_information": [ { "code": "197", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8266.0, "minimum": 6852.12, "maximum": 17901.41, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7974.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 17150.09 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7974.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7974.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 17901.41 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8266.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6852.12 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8266.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17901.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7974.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8266.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7974.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10555.59 } ] } ] }, { "description": "DIGESTIVE MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "376", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8077.0, "minimum": 6111.53, "maximum": 19990.04, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7793.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 16701.95 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7793.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7793.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 19990.04 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8077.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6111.53 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8077.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19990.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7793.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8077.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7793.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10279.77 } ] } ] }, { "description": "HC (SUP SHELL A6257) TRANSPARENT FILM <= 16 SQ IN - A6257 - RU272058", "code_information": [ { "code": "A6257", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 2.0, "minimum": 2.1185, "maximum": 3.6868, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2.18, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2.65, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2.12, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.38, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3.69, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL Q4257) RELESE, PER SQ CM", "code_information": [ { "code": "Q4257", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 126.52, "maximum": 1064.121, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1064.12 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC", "code_information": [ { "code": "085", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18326.0, "minimum": 15683.73, "maximum": 41052.8695, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17627.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 41052.87 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 17627.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 17627.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 36901.69 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 18326.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15683.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18326.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 36901.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17627.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 18326.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17627.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25267.34 } ] } ] }, { "description": "HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC", "code_information": [ { "code": "970", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21106.0, "minimum": 18364.36, "maximum": 57037.85, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 20295.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 47657.4 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 20295.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 20295.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 57037.85 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 21106.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18364.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21106.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 57037.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 20295.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 21106.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 20295.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 29332.32 } ] } ] }, { "description": "HC PATH CONSULT IN SURG,W ADDN FRZ SEC", "code_information": [ { "code": "88332", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 143.44, "minimum": 43.032, "maximum": 143.44, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 143.44 } ] } ] }, { "description": "HC ASSAY OF MAGNESIUM", "code_information": [ { "code": "83735", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 107.5, "discounted_cash": 6.0, "minimum": 6.5111, "maximum": 93.74, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 68.0, "10th_percentile": 57.12, "90th_percentile": 68.0, "count": "38" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.14, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 64.85, "10th_percentile": 54.15, "90th_percentile": 74.12, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 57.18, "10th_percentile": 57.18, "90th_percentile": 58.28, "count": "81" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.16 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 29.95, "10th_percentile": 17.15, "90th_percentile": 68.0, "count": "30" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 74.12, "10th_percentile": 35.16, "90th_percentile": 74.8, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.33, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC VENOGRAM SINUS/JUGULAR", "code_information": [ { "code": "75860", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2597.5, "discounted_cash": 3115.0, "minimum": 640.6242, "maximum": 2597.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2597.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2597.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2597.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2597.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2597.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 640.62 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2597.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2597.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2597.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2597.5, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2597.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2597.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2597.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2597.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2597.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2597.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Azithromycin Tab 250 MG", "drug_information": { "unit": 50.0, "type": "EA" }, "code_information": [ { "code": "00904735006", "type": "NDC" }, { "code": "Q0144", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 54.1585, "maximum": 54.1585, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 54.16 } ] } ] }, { "description": "HC CT ANGIO, CHEST, COMBO, INCL IMAGE PROC", "code_information": [ { "code": "71275", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2631.25, "discounted_cash": 173.0, "minimum": 173.07, "maximum": 2294.45, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 726.24, "10th_percentile": 363.12, "90th_percentile": 736.3, "count": "17" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 681.83, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 828.26, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 662.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1605.48, "10th_percentile": 1543.72, "90th_percentile": 1605.48, "count": "16" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1787.2 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 725.62, "10th_percentile": 725.62, "90th_percentile": 725.62, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 1747.46, "10th_percentile": 1522.28, "90th_percentile": 1835.56, "count": "17" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 292.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MICROSOMAL ANTIBODY", "code_information": [ { "code": "86376", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 327.19, "discounted_cash": 14.0, "minimum": 14.1397, "maximum": 285.3097, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 197.6, "10th_percentile": 165.98, "90th_percentile": 197.6, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.55, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.67, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 166.73, "10th_percentile": 166.73, "90th_percentile": 166.73, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 169.34, "10th_percentile": 169.34, "90th_percentile": 176.08, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 76.35 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 14.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 65.04, "10th_percentile": 65.04, "90th_percentile": 65.04, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.86, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 217.36, "10th_percentile": 76.35, "90th_percentile": 228.25, "count": "12" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 14.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.61, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC VENOGRAM INFER VENA CAVA", "code_information": [ { "code": "75825", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8263.75, "discounted_cash": 3115.0, "minimum": 541.162, "maximum": 8263.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8263.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8263.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8263.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 541.16 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5268.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REVSC EVASC TPVT ATHRC UNI CPLX LES 1ST VSL", "code_information": [ { "code": "37290", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 88727.2, "discounted_cash": 18087.0, "minimum": 18087.87, "maximum": 86563.1195, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 71258.97, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 86563.12, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 69253.03, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19715.78, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30590.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC", "code_information": [ { "code": "240", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22727.0, "minimum": 20156.3, "maximum": 95394.95, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 21850.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 51508.08 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 21850.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 21850.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 95394.95 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 22727.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20156.3 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22727.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 95394.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 21850.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 22727.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 21850.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 31702.35 } ] } ] }, { "description": "HC CLSD TREAT MT-PHAL TOE DISLOC WO ANES", "code_information": [ { "code": "28630", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 405.31, "discounted_cash": 243.0, "minimum": 121.593, "maximum": 405.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 405.31, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 405.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 405.31, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 405.31, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ANTIBIOTIC SENS,MIC,EACH", "code_information": [ { "code": "87186", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 156.88, "discounted_cash": 8.0, "minimum": 8.4061, "maximum": 136.7994, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 94.8, "10th_percentile": 79.63, "90th_percentile": 94.8, "count": "14" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.51, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8.41, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 75.48, "10th_percentile": 75.48, "90th_percentile": 75.48, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 81.24, "10th_percentile": 79.72, "90th_percentile": 239.14, "count": "18" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 45.39 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 38.67, "10th_percentile": 38.67, "90th_percentile": 94.8, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 103.33, "10th_percentile": 103.33, "90th_percentile": 104.28, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.63, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CCMCC", "code_information": [ { "code": "373", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6580.0, "minimum": 5020.73, "maximum": 18179.1212, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6356.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 13144.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6356.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6356.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 10248.3 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6580.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5020.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6580.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10248.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6356.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 6580.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6356.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8089.91 } ] } ] }, { "description": "Midazolam HCl Oral/Rectal/Inj 5 MG/ML (Base Equivalent)", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00641606101", "type": "NDC" }, { "code": "J2250", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 30.26, "10th_percentile": 30.26, "90th_percentile": 30.26, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "UNCOMPLICATED PEPTIC ULCER WITHOUT MCC", "code_information": [ { "code": "384", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7549.0, "minimum": 6018.79, "maximum": 17694.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7286.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 15446.1 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7286.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7286.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 17694.89 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7549.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6018.79 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7549.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17694.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7286.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7549.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7286.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9506.81 } ] } ] }, { "description": "HC XR FLUORO GUIDANCE CV/PICC LINE", "code_information": [ { "code": "77001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 730.0, "minimum": 219.0, "maximum": 710.7578, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 448.6, "10th_percentile": 448.6, "90th_percentile": 448.6, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 427.68, "10th_percentile": 427.68, "90th_percentile": 427.68, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 710.76 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 312.5, "10th_percentile": 312.5, "90th_percentile": 312.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 429.87, "10th_percentile": 411.18, "90th_percentile": 493.46, "count": "1 through 10" } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITH MCC", "code_information": [ { "code": "347", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18506.0, "minimum": 16381.4, "maximum": 81689.6838, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17800.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 41481.12 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 17800.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 17800.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 49645.82 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 18506.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16381.4 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18506.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 49645.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17800.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 18506.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17800.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25530.93 } ] } ] }, { "description": "HC CLSD TREAT NASAL SEPTAL FX", "code_information": [ { "code": "21337", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2236.88, "discounted_cash": 3271.0, "minimum": 671.064, "maximum": 2236.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2236.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2236.88, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2236.88, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2236.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2236.88, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2236.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2236.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2236.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2236.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2236.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2236.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2236.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2236.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2236.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2236.88, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "GASTROINTESTINAL HEMORRHAGE WITHOUT CCMCC", "code_information": [ { "code": "379", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5842.0, "minimum": 4406.81, "maximum": 18378.486, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5648.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 11391.23 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 5648.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 5648.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 10298.96 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "other", "standard_charge_dollar": 18336.33, "standard_charge_algorithm": "87% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 20188.92, "10th_percentile": 20188.92, "90th_percentile": 20188.92, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 5842.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4406.81 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5842.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10299.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5648.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 5842.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 5648.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7011.11 } ] } ] }, { "description": "LIMB REATTACHMENT, HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA", "code_information": [ { "code": "956", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 29667.0, "minimum": 26456.09, "maximum": 150749.43, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 29667.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 28509.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 41850.88 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 28509.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 67996.81 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 28509.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 28509.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 150749.43 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 29667.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26456.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 29667.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 150749.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 28509.4, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC OT EXERCISE OTA COMPLEX EA 15 - G0237 - 42000162", "code_information": [ { "code": "G0237", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 147.5, "discounted_cash": 28.0, "minimum": 28.53, "maximum": 136.536, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 112.4, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 136.54, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 109.23, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.1, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 48.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Ciprofloxacin 400 MG/200ML in D5W", "drug_information": { "unit": 200.0, "type": "ML" }, "code_information": [ { "code": "25021019287", "type": "NDC" }, { "code": "J0744", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 4.515, "maximum": 4.515, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.52 } ] } ] }, { "description": "HC (SUP SHELL A4456) ADHESIVE REMOVER, WIPES", "code_information": [ { "code": "A4456", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ANGRPH CATH F-UP STD TCAT OTHR THAN THROMBYLSIS", "code_information": [ { "code": "75898", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 377.81, "discounted_cash": 3115.0, "minimum": 113.343, "maximum": 377.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 377.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 377.81, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 377.81, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 377.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 377.81, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 377.81 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 377.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 377.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 377.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 377.81, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 377.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 377.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 377.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 377.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 377.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 377.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC", "code_information": [ { "code": "727", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12326.0, "minimum": 10170.2, "maximum": 81076.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11869.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 26795.77 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11869.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11869.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 32069.79 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12326.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10170.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12326.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32069.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11869.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 12326.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11869.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16492.34 } ] } ] }, { "description": "HC (SUP SHELL L3060) FOOT ARCH SUPP LONGITUD/META", "code_information": [ { "code": "L3060", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 88.0, "minimum": 85.9557, "maximum": 149.5866, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 88.45, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 107.44, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 85.96, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 88.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 88.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 96.41, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 88.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 88.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 149.59, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ANGIO PULMON BILAT NONSELEC", "code_information": [ { "code": "75746", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2587.19, "discounted_cash": 3115.0, "minimum": 728.3266, "maximum": 2587.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2587.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2587.19, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2587.19, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2587.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2587.19, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 728.33 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2587.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2587.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2587.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2587.19, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2587.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2587.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2587.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2587.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2587.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2587.19, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC RETICULOCYTE COUNT, AUTO", "code_information": [ { "code": "85045", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 128.44, "discounted_cash": 3.0, "minimum": 3.8775, "maximum": 111.9997, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 77.6, "10th_percentile": 77.6, "90th_percentile": 77.6, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.99, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.85, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3.88, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 65.45, "10th_percentile": 65.45, "90th_percentile": 65.45, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.94 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 17.84, "10th_percentile": 17.84, "90th_percentile": 17.84, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 85.36, "10th_percentile": 3.99, "90th_percentile": 89.6, "count": "16" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTITIS MEDIA AND URI WITH MCC", "code_information": [ { "code": "152", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10039.0, "minimum": 7854.33, "maximum": 21362.1648, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9675.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 21362.16 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9675.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9675.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 12798.69 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 10039.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7854.33 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10039.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12798.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9675.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 10039.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9675.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13148.05 } ] } ] }, { "description": "HC MRI ABDOMEN WO CONTRAST", "code_information": [ { "code": "74181", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1936.56, "discounted_cash": 235.0, "minimum": 235.42, "maximum": 1688.6803, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 927.46, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1126.65, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 901.35, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1167.12 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 256.61, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "EXTRAOCULAR PROCEDURES EXCEPT ORBIT", "code_information": [ { "code": "115", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12721.0, "minimum": 10596.56, "maximum": 33194.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12249.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 27735.4 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12249.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12249.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 33193.98 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12721.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10596.56 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12721.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 33194.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12249.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 12721.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12249.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17070.67 } ] } ] }, { "description": "HC ASSAY OF SELENIUM", "code_information": [ { "code": "84255", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 346.88, "discounted_cash": 25.0, "minimum": 24.8101, "maximum": 302.4794, "payers_information": [ { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.83, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.18, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 31.01, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 24.81, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 190.25, "10th_percentile": 190.25, "90th_percentile": 190.25, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 133.96 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "SKIN ULCERS WITH CC", "code_information": [ { "code": "593", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10070.0, "minimum": 8462.71, "maximum": 32213.5897, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9705.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 21436.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9705.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9705.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 17811.78 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 10070.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8462.71 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10070.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17811.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9705.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 10070.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9705.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13193.65 } ] } ] }, { "description": "HC ENDOVEN ABLTI THER CHEM ADHESIVE 1ST VEIN", "code_information": [ { "code": "36482", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21352.5, "discounted_cash": 5490.0, "minimum": 5490.48, "maximum": 21352.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 21352.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 21352.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 21021.4, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5984.62, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9285.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC LEGION PNEUMO AG, DFA", "code_information": [ { "code": "87278", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 239.06, "discounted_cash": 15.0, "minimum": 15.1601, "maximum": 208.4603, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.6, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.95, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 15.16, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 81.86 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 15.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 15.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 15.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.38, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CESAREAN SECTION WITHOUT STERILIZATION WITH CC", "code_information": [ { "code": "787", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9541.0, "minimum": 7349.07, "maximum": 28846.1191, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 25968.12, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 490.45, "10th_percentile": 490.45, "90th_percentile": 23592.52, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9198.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 20180.4 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9198.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "other", "standard_charge_dollar": 24545.67, "standard_charge_algorithm": "74.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 34307.05, "10th_percentile": 34307.05, "90th_percentile": 34307.05, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 25309.82, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 16032.53, "10th_percentile": 16032.53, "90th_percentile": 16032.53, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9198.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 22405.98 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "other", "standard_charge_dollar": 28779.96, "standard_charge_algorithm": "87% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 22577.52, "10th_percentile": 22577.52, "90th_percentile": 22577.52, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9541.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7349.07 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9541.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22406.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 28846.12, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 42036.85, "10th_percentile": 30050.83, "90th_percentile": 65338.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9198.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 9541.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9198.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12420.69 } ] } ] }, { "description": "HC CLSD TREAT RAD/ULNA SHAFT FX WO MANIP", "code_information": [ { "code": "25560", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 404.06, "discounted_cash": 243.0, "minimum": 121.218, "maximum": 404.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MOG-IGG1 ANTB CBA EACH", "code_information": [ { "code": "86362", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2515.0, "discounted_cash": 12.0, "minimum": 11.7102, "maximum": 2193.08, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.64, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.71, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 63.23 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 53.86, "10th_percentile": 53.86, "90th_percentile": 53.86, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.38, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DUPLEX HEMODIALYSIS ACCESS", "code_information": [ { "code": "93990", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 884.06, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 770.9003, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC NM ACUTE GI BLOOD LOSS IMAGING", "code_information": [ { "code": "78278", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1004.38, "discounted_cash": 394.0, "minimum": 301.314, "maximum": 1004.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1004.38, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1004.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1004.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1004.38 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MALIGNANT BREAST DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "599", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6899.0, "minimum": 5917.05, "maximum": 16638.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6662.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 13902.93 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6662.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6662.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 16638.89 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6899.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5917.05 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6899.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16638.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6662.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 6899.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6662.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8557.02 } ] } ] }, { "description": "Diphenhydramine HCl Liquid 12.5 MG/5ML", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "60687083042", "type": "NDC" }, { "code": "Q0163", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC MRI, CERV SPINE", "code_information": [ { "code": "72141", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2406.88, "discounted_cash": 235.0, "minimum": 235.42, "maximum": 2098.7994, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 256.61, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 1679.04, "10th_percentile": 738.05, "90th_percentile": 1694.44, "count": "16" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1293.94, "10th_percentile": 488.62, "90th_percentile": 1293.94, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 927.46, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1126.65, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 901.35, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1468.58, "10th_percentile": 1468.58, "90th_percentile": 1496.88, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1111.51 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 503.23, "10th_percentile": 503.23, "90th_percentile": 503.23, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CCMCC", "code_information": [ { "code": "282", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6547.0, "minimum": 5018.66, "maximum": 24219.1659, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6325.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 13066.3 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6325.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 21250.1, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 24611.3, "10th_percentile": 24611.3, "90th_percentile": 24611.3, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6325.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 18945.73 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6547.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5018.66 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6547.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18945.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6325.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 6547.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6325.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8042.09 } ] } ] }, { "description": "BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC", "code_information": [ { "code": "519", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16260.0, "minimum": 13648.17, "maximum": 107497.7271, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15645.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 36143.29 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 15645.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 15645.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 44110.57 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 16260.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13648.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16260.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 44110.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15645.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 16260.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15645.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22245.58 } ] } ] }, { "description": "ANGINA PECTORIS", "code_information": [ { "code": "311", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6386.0, "minimum": 4833.16, "maximum": 14822.5747, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6170.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 12683.22 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6170.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 13005.45, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 7114.54, "10th_percentile": 7114.54, "90th_percentile": 7114.54, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6170.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 11321.84 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6386.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4833.16 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6386.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11321.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6170.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 6386.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6170.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7806.31 } ] } ] }, { "description": "HC REMOVAL FOOT FB DEEP", "code_information": [ { "code": "28192", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1949.69, "discounted_cash": 1629.0, "minimum": 584.907, "maximum": 1949.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1949.69, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1949.69, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1949.69, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1776.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1949.69, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6253) ABSORPT DRG > 48 SQ IN W/O B - A6253 - RU272055", "code_information": [ { "code": "A6253", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 9.0, "minimum": 8.7754, "maximum": 15.2715, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.03, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.97, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8.78, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 9.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 9.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.84, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 9.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.27, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC", "code_information": [ { "code": "266", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 47656.0, "minimum": 41464.3, "maximum": 110739.2075, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 45771.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 110739.21 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 45771.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 45771.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 79404.87 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 47656.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41464.3 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 47656.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 79404.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 45771.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 47656.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 45771.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 68158.1 } ] } ] }, { "description": "MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC", "code_information": [ { "code": "344", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20691.0, "minimum": 18649.52, "maximum": 55857.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 19896.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 46670.78 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 19896.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 19896.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 55857.15 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 20691.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18649.52 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20691.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 55857.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 19896.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 20691.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 19896.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28725.08 } ] } ] }, { "description": "HC RUBEOLA", "code_information": [ { "code": "86765", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 56.25, "discounted_cash": 12.0, "minimum": 12.5168, "maximum": 56.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 34.0, "10th_percentile": 34.0, "90th_percentile": 42.5, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.65, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.52, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 28.67, "10th_percentile": 28.67, "90th_percentile": 28.67, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 29.14, "10th_percentile": 29.14, "90th_percentile": 30.27, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 56.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 42.5, "10th_percentile": 42.5, "90th_percentile": 42.5, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 39.24, "10th_percentile": 37.4, "90th_percentile": 67.36, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.78, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ED LEVEL 3", "code_information": [ { "code": "99283", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1074.06, "discounted_cash": 269.0, "minimum": 269.34, "maximum": 1074.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 502.15, "10th_percentile": 502.15, "90th_percentile": 597.8, "count": "47" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 269.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1061.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1074.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 269.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1031.22, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.3, "median_amount": 875.18, "10th_percentile": 602.32, "90th_percentile": 1545.9, "count": "63" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 655.35, "10th_percentile": 580.91, "90th_percentile": 655.35, "count": "55" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 777.22, "10th_percentile": 582.52, "90th_percentile": 857.2, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 269.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 269.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 674.51, "10th_percentile": 591.82, "90th_percentile": 674.51, "count": "30" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 269.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 293.58, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 269.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 269.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 657.58, "10th_percentile": 657.58, "90th_percentile": 657.58, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 269.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 269.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 269.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 455.51, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MODER SEDATE SAME PHYS/QHP EACH ADDL 15 MIN", "code_information": [ { "code": "99153", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 472.81, "minimum": 141.843, "maximum": 412.2903, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 278.98, "10th_percentile": 76.98, "90th_percentile": 310.07, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1400.29, "10th_percentile": 576.98, "90th_percentile": 1442.46, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 289.97, "10th_percentile": 289.97, "90th_percentile": 315.07, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 352.25, "10th_percentile": 317.02, "90th_percentile": 1979.0, "count": "1 through 10" } ] } ] }, { "description": "HC CT HEART CNTRST EVAL STRUCT/MORPH, CONGEN DISEASE", "code_information": [ { "code": "75573", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1814.06, "discounted_cash": 344.0, "minimum": 344.22, "maximum": 1693.6197, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1356.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1647.33, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1317.92, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1693.62 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC SLCTV CATH 1STORD W/WO ART PUNCT/FLUOR/S&I BILA", "code_information": [ { "code": "36252", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9039.06, "discounted_cash": 3115.0, "minimum": 2711.718, "maximum": 9039.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9039.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9039.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9039.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5268.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC BODY FLUID CELL COUNT W DIFF", "code_information": [ { "code": "89051", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 159.06, "discounted_cash": 5.0, "minimum": 5.4421, "maximum": 138.7003, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 96.0, "10th_percentile": 96.0, "90th_percentile": 96.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.8, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 81.06, "10th_percentile": 81.06, "90th_percentile": 81.06, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 85.6, "10th_percentile": 85.6, "90th_percentile": 85.6, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.38 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.1, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 110.96, "10th_percentile": 110.96, "90th_percentile": 110.96, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC EVASC RPR DPLMNT AORTO-AORTIC NDGFT", "code_information": [ { "code": "34701", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14699.7, "minimum": 4409.91, "maximum": 14699.7, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 14699.7 } ] } ] }, { "description": "HC ERCP DX COLLECTION SPECIMEN BRUSHING/WASHING", "code_information": [ { "code": "43260", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7151.56, "discounted_cash": 3804.0, "minimum": 2145.468, "maximum": 7151.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7151.56, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7151.56, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7151.56, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4146.58, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3804.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6433.66, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INJ PROC SHOULDER ARTHROGRAPHY/CT/MRI", "code_information": [ { "code": "23350", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 944.06, "minimum": 283.218, "maximum": 823.2203, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 507.53, "10th_percentile": 507.53, "90th_percentile": 507.53, "count": "1 through 10" } ] } ] }, { "description": "HC CT SCAN,MAXILLOFACIAL AREA,W/O CONTRAST", "code_information": [ { "code": "70486", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1417.19, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 1235.7897, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 694.68, "10th_percentile": 354.52, "90th_percentile": 694.68, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 835.73, "10th_percentile": 567.7, "90th_percentile": 864.71, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 801.44 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 988.63, "10th_percentile": 988.63, "90th_percentile": 988.63, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 909.7, "10th_percentile": 840.0, "90th_percentile": 988.63, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Lidocaine Inj 2% w/ Epinephrine-1:200000 (PF)", "drug_information": { "unit": 20.0, "type": "ML" }, "code_information": [ { "code": "00409318311", "type": "NDC" }, { "code": "J2004", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 11.99, "10th_percentile": 11.99, "90th_percentile": 11.99, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 14.84, "10th_percentile": 14.84, "90th_percentile": 14.84, "count": "1 through 10" } ] } ] }, { "description": "HC CT SCAN,ABDOMEN,W/O CONTRAST", "code_information": [ { "code": "74150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2172.19, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 1894.1497, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 740.02 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MYELOGRAPHY LUMBAR INJ, 2+ REGIONS", "code_information": [ { "code": "62305", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1964.38, "discounted_cash": 773.0, "minimum": 589.314, "maximum": 1964.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1964.38, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1964.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1964.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 843.1, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1308.13, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4450) NON-WATERPROOF TAPE - A4450 - 27090028", "code_information": [ { "code": "A4450", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INJECTION TREATMENT OF NERVE", "code_information": [ { "code": "64620", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4217.81, "discounted_cash": 872.0, "minimum": 872.7, "maximum": 4176.4804, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3438.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4176.48, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3341.31, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 951.24, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1475.91, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF PORPHOBILINOGEN URINE QUAN", "code_information": [ { "code": "84110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 402.81, "discounted_cash": 8.0, "minimum": 8.202, "maximum": 351.2503, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.25, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8.2, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.29 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.27, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Propofol IV Emul 100 MG/10ML (10 MG/ML)", "drug_information": { "unit": 20.0, "type": "ML" }, "code_information": [ { "code": "25021060820", "type": "NDC" }, { "code": "J2704", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC REVSC EVASC FPVT ST PLMT UNI SF LES 1ST VSL", "code_information": [ { "code": "37267", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 55875.3, "discounted_cash": 11390.0, "minimum": 11390.68, "maximum": 54512.3773, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 44874.72, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 54512.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 43611.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12415.84, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19263.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC", "code_information": [ { "code": "233", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 59192.0, "minimum": 54099.88, "maximum": 178768.2491, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 56840.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 138147.54 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 56840.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 56840.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 162973.35 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 59192.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 54099.88 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 59192.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 162973.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 56840.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 59192.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 56840.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 85027.47 } ] } ] }, { "description": "KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC", "code_information": [ { "code": "690", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7204.0, "minimum": 5555.06, "maximum": 21556.715, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 19405.99, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 8945.1, "10th_percentile": 8945.1, "90th_percentile": 8945.1, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6955.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 14627.54 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6955.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6955.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 11590.71 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7204.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5555.06 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7204.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11590.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6955.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7204.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6955.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9003.0 } ] } ] }, { "description": "CONNECTIVE TISSUE DISORDERS WITH MCC", "code_information": [ { "code": "545", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19922.0, "minimum": 17489.51, "maximum": 98648.5098, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 19158.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 44843.92 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 19158.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 19158.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 65579.4 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 19922.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17489.51 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19922.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 65579.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 19158.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 19922.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 19158.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27600.67 } ] } ] }, { "description": "Levalbuterol HCl Soln Nebu 0.31 MG/3ML (Base Equiv)", "drug_information": { "unit": 3.0, "type": "ML" }, "code_information": [ { "code": "76204070011", "type": "NDC" }, { "code": "J7614", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC HEPATITIS B SURFACE AG, EIA", "code_information": [ { "code": "87340", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 136.56, "discounted_cash": 10.0, "minimum": 10.0387, "maximum": 119.0803, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 82.4, "10th_percentile": 46.18, "90th_percentile": 82.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.55, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 10.04, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 65.61, "10th_percentile": 65.61, "90th_percentile": 65.61, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 73.49, "10th_percentile": 70.62, "90th_percentile": 73.49, "count": "37" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 54.2 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 46.18, "10th_percentile": 46.18, "90th_percentile": 46.18, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.26, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 90.64, "10th_percentile": 90.64, "90th_percentile": 90.64, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.47, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITH MCC", "code_information": [ { "code": "278", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 43381.0, "minimum": 34629.49, "maximum": 108425.5351, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 41668.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 100580.34 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 41668.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "other", "standard_charge_dollar": 92261.18, "standard_charge_algorithm": "74.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 89871.41, "10th_percentile": 89871.41, "90th_percentile": 89871.41, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 41668.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 71747.86 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 43381.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34629.49 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 43381.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 71747.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 41668.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 43381.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 41668.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 61905.5 } ] } ] }, { "description": "HC OPN ILIAC ART EXPOS PROSTH/ILIAC OCCLS EVASC UNI", "code_information": [ { "code": "34820", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13938.4, "minimum": 4181.52, "maximum": 13938.4, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 13938.4 } ] } ] }, { "description": "Acetylcysteine Inhal Soln 10%", "drug_information": { "unit": 4.0, "type": "ML" }, "code_information": [ { "code": "00517750401", "type": "NDC" }, { "code": "J7608", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 18.146, "maximum": 18.146, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.15 } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC", "code_information": [ { "code": "191", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7459.0, "minimum": 5946.11, "maximum": 18482.2202, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7200.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 15232.88 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7200.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7200.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 14620.4 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7459.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5946.11 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7459.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14620.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 18482.22, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 15698.72, "10th_percentile": 15698.72, "90th_percentile": 15698.72, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7200.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7459.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7200.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9375.58 } ] } ] }, { "description": "HC (SUP SHELL Q4146) TENSIX, 1CM", "code_information": [ { "code": "Q4146", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 126.52, "maximum": 605.4868, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REVASC LITHOTR-ATHER TIB/PER", "code_information": [ { "code": "C9774", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 71019.1, "discounted_cash": 18087.0, "minimum": 18087.87, "maximum": 71019.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 71019.1, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 71019.1, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 69253.03, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19715.78, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30590.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ANGIO AORTOGRAM THORACIC", "code_information": [ { "code": "75600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8860.31, "discounted_cash": 3115.0, "minimum": 1398.2086, "maximum": 8860.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8860.31, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8860.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8860.31, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1398.21 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5268.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Magnesium Sulfate IV Soln 4 GM/100ML (40 MG/ML)", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "00338171540", "type": "NDC" }, { "code": "J3475", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0535, "maximum": 1.0535, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.05 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 72.46, "10th_percentile": 72.46, "90th_percentile": 144.91, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 80.49, "10th_percentile": 80.49, "90th_percentile": 80.49, "count": "1 through 10" } ] } ] }, { "description": "HC XRAY HIPS W PELVIS, BILAT =>5 VW", "code_information": [ { "code": "73523", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 679.69, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 592.6897, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 414.72, "10th_percentile": 398.81, "90th_percentile": 414.72, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 412.44 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 410.4, "10th_percentile": 410.4, "90th_percentile": 410.4, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 451.44, "10th_percentile": 451.44, "90th_percentile": 474.15, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 410.4, "10th_percentile": 410.4, "90th_percentile": 410.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC INTRA-ATRIAL RECORDING", "code_information": [ { "code": "93602", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3523.13, "discounted_cash": 7695.0, "minimum": 1056.939, "maximum": 3523.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CYSTO FRAGMENTATION URETERAL STONE", "code_information": [ { "code": "52325", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7100.31, "discounted_cash": 5290.0, "minimum": 2130.093, "maximum": 7100.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5290.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7100.31, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7100.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5290.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7100.31, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5290.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5290.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5290.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5766.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5290.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5290.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5290.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5290.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5290.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7100.31, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC RMVL OF SUBQ IMPLANTABLE DEFIBRILLATOR ELECTRODE", "code_information": [ { "code": "33272", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8889.06, "discounted_cash": 3687.0, "minimum": 2666.718, "maximum": 8889.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8889.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8889.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8889.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4019.11, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6235.89, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CCMCC", "code_information": [ { "code": "928", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 55599.0, "minimum": 46226.87, "maximum": 129609.5414, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 53392.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 129609.54 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 53392.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 53392.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 78832.06 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 55599.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46226.87 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 55599.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 78832.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 53392.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 55599.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 53392.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 79772.47 } ] } ] }, { "description": "HC (SUP SHELL A4221) SUPP NON-INSULIN INF CATH/WK", "code_information": [ { "code": "A4221", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 25.0, "minimum": 25.1405, "maximum": 43.7513, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 25.87, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 31.42, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 25.14, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 25.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 25.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 25.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC KETONE BODIES SERUM QUANTITATIVE", "code_information": [ { "code": "82010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 97.19, "discounted_cash": 8.0, "minimum": 7.9396, "maximum": 84.7497, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 36.52, "10th_percentile": 36.52, "90th_percentile": 36.52, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.92, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7.94, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 52.3, "10th_percentile": 52.3, "90th_percentile": 53.31, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 42.87 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 68.42, "10th_percentile": 67.8, "90th_percentile": 68.42, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.82, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PSYCH DIAGNOSTIC EVALUATION", "code_information": [ { "code": "90791", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 548.75, "discounted_cash": 175.0, "minimum": 164.625, "maximum": 548.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 175.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 548.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 548.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 175.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 548.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 175.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 175.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 175.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 190.89, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 175.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 175.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 175.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 175.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 175.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 296.18, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT ULNA SHAFT FX W MANIP", "code_information": [ { "code": "25535", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 404.06, "discounted_cash": 243.0, "minimum": 121.218, "maximum": 404.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Cefepime HCl For IV Soln 2 GM", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "44567024110", "type": "NDC" }, { "code": "J0692", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2.58, "maximum": 2.58, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2.58 } ] } ] }, { "description": "HC ASSAY URINE UREA-N", "code_information": [ { "code": "84540", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 84.06, "discounted_cash": 5.0, "minimum": 5.4032, "maximum": 73.3003, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.75, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.4, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.17 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.06, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.4, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC BILIRUBIN DIRECT", "code_information": [ { "code": "82248", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 47.19, "discounted_cash": 5.0, "minimum": 4.8784, "maximum": 41.1497, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 24.05, "10th_percentile": 24.05, "90th_percentile": 24.05, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 25.39, "10th_percentile": 25.39, "90th_percentile": 25.88, "count": "12" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.34 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 22.44, "10th_percentile": 22.44, "90th_percentile": 22.44, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.47, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 32.92, "10th_percentile": 26.25, "90th_percentile": 33.22, "count": "20" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.49, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 25.37, "10th_percentile": 22.44, "90th_percentile": 30.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.1, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" } ] } ] }, { "description": "HC PH BODY FLUID NOS", "code_information": [ { "code": "83986", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 78.44, "discounted_cash": 3.0, "minimum": 3.479, "maximum": 68.3997, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.58, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3.48, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.79 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.9, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.05, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ELECTRON MICROSCOPY,DIAGNOSTIC", "code_information": [ { "code": "88348", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1577.5, "discounted_cash": 794.0, "minimum": 473.25, "maximum": 1577.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 794.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1577.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1577.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 794.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1577.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1577.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 794.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 794.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 794.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 866.52, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 794.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 794.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 794.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 794.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 794.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1344.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Ropivacaine HCl Inj 2 MG/ML", "drug_information": { "unit": 200.0, "type": "ML" }, "code_information": [ { "code": "25021067187", "type": "NDC" }, { "code": "J2795", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 35.84, "10th_percentile": 11.99, "90th_percentile": 35.84, "count": "13" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 35.84, "10th_percentile": 35.84, "90th_percentile": 37.78, "count": "1 through 10" } ] } ] }, { "description": "HC HEP B CORE AB TEST, TOTAL", "code_information": [ { "code": "86704", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 144.06, "discounted_cash": 12.0, "minimum": 11.7102, "maximum": 125.6203, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 87.0, "10th_percentile": 53.86, "90th_percentile": 87.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.64, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.71, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 73.41, "10th_percentile": 73.41, "90th_percentile": 146.82, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 77.53, "10th_percentile": 74.56, "90th_percentile": 77.53, "count": "23" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 63.23 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 53.86, "10th_percentile": 53.86, "90th_percentile": 53.86, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 95.7, "10th_percentile": 95.7, "90th_percentile": 95.7, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.38, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CHANGE OF BLADDER TUBE,SIMPLE", "code_information": [ { "code": "51705", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1221.88, "discounted_cash": 246.0, "minimum": 246.53, "maximum": 1179.8186, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 971.23, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1179.82, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 943.89, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 268.72, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 416.93, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PERITONEAL LAVAGE W/WO IMAGING GUIDANCE", "code_information": [ { "code": "49084", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2567.19, "discounted_cash": 894.0, "minimum": 770.157, "maximum": 2567.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2567.19, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2567.19, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2567.19, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 975.46, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 894.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1513.49, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC EPSTEIN-BARR ANTIBODY,V CAPSID", "code_information": [ { "code": "86665", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 225.63, "discounted_cash": 18.0, "minimum": 17.6285, "maximum": 196.7494, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 272.4, "10th_percentile": 272.4, "90th_percentile": 272.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.03, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 229.96, "10th_percentile": 229.96, "90th_percentile": 229.96, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.18 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 162.17, "10th_percentile": 162.17, "90th_percentile": 162.17, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.77, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 190.36, "10th_percentile": 149.82, "90th_percentile": 314.79, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.68, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY ALKALINE PHOSPHATASE", "code_information": [ { "code": "84075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 83.13, "discounted_cash": 5.0, "minimum": 5.0339, "maximum": 72.4894, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 44.69, "10th_percentile": 44.69, "90th_percentile": 53.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.29, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.03, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 42.36, "10th_percentile": 42.36, "90th_percentile": 42.36, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 45.59, "10th_percentile": 33.42, "90th_percentile": 45.59, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.18 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 23.15, "10th_percentile": 23.15, "90th_percentile": 53.2, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 58.52, "10th_percentile": 42.9, "90th_percentile": 58.52, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF ETHYLENE GLYCOL", "code_information": [ { "code": "82693", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1101.88, "discounted_cash": 14.0, "minimum": 14.4798, "maximum": 960.8394, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.1, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 78.18 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.2, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CCMCC", "code_information": [ { "code": "903", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9943.0, "minimum": 8437.79, "maximum": 21134.4849, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9583.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 21134.48 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9583.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9583.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 17478.62 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9943.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8437.79 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9943.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17478.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9583.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 9943.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9583.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13007.92 } ] } ] }, { "description": "HC REMOVAL FB GUM", "code_information": [ { "code": "41805", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2236.88, "discounted_cash": 1530.0, "minimum": 671.064, "maximum": 2236.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2236.88, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2236.88, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2236.88, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1668.74, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2236.88, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Ertapenem Sodium For Inj 1 GM (Base Equivalent)", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "43598090111", "type": "NDC" }, { "code": "J1335", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 19.737, "maximum": 19.737, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.74 } ] } ] }, { "description": "HC (SUP SHELL A4326) MALE EXTERNAL CATHETER", "code_information": [ { "code": "A4326", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 14.0, "minimum": 14.3632, "maximum": 24.9959, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.95, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.36, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.11, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC BFB TRAING W/EMG &/MANOMETRY 1ST 15 MIN CNTCT", "code_information": [ { "code": "90912", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 188.13, "discounted_cash": 36.0, "minimum": 35.2958, "maximum": 164.0494, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 36.32, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 44.12, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 35.3, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 36.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 36.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.59, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 36.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 61.42, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ANGIO ADRENAL BILAT SELECT", "code_information": [ { "code": "75733", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1634.06, "discounted_cash": 3115.0, "minimum": 490.218, "maximum": 1634.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 985.77 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF TRANSFERRIN", "code_information": [ { "code": "84466", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 221.88, "discounted_cash": 12.0, "minimum": 12.4002, "maximum": 193.4794, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 142.0, "10th_percentile": 142.0, "90th_percentile": 142.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.4, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 113.07, "10th_percentile": 113.07, "90th_percentile": 113.07, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 119.4, "10th_percentile": 119.4, "90th_percentile": 121.69, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 66.95 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 66.95, "10th_percentile": 12.76, "90th_percentile": 154.78, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.58, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ECHO HEART,TRANSESOPHAGEAL,COMPLETE", "code_information": [ { "code": "93312", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3845.0, "discounted_cash": 539.0, "minimum": 539.15, "maximum": 3352.84, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 539.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2124.04, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2580.21, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 539.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2064.24, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 2358.06, "10th_percentile": 2358.06, "90th_percentile": 2358.06, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 539.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 539.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 539.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 587.67, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 539.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 539.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 539.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 539.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 539.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 911.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4217) STERILE WATER/SALINE, 500 ML", "code_information": [ { "code": "A4217", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 3.0, "minimum": 3.6928, "maximum": 6.4266, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.8, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.62, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3.69, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.14, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.43, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Ciprofloxacin 200 MG/100ML in D5W", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "25021011482", "type": "NDC" }, { "code": "J0744", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 4.515, "maximum": 4.515, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.52 } ] } ] }, { "description": "VIRAL MENINGITIS WITHOUT CCMCC", "code_information": [ { "code": "076", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7323.0, "minimum": 6346.17, "maximum": 14911.232, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7070.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 14911.23 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7070.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7070.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 9691.07 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7323.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6346.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7323.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9691.07 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7070.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7323.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7070.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9177.61 } ] } ] }, { "description": "HYPERTENSIVE ENCEPHALOPATHY WITH MCC", "code_information": [ { "code": "077", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10702.45, "maximum": 10702.45, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10702.45 } ] } ] }, { "description": "HC EXC SKIN BENIG <0.5 CM SCALP/NECK/HND/FT/GENT", "code_information": [ { "code": "11420", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4403.44, "discounted_cash": 1629.0, "minimum": 1321.032, "maximum": 4403.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4403.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4403.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4403.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1776.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2756.05, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INJECT TRIGGER POINT1-2 MUSCLE", "code_information": [ { "code": "20552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1200.0, "discounted_cash": 302.0, "minimum": 302.87, "maximum": 1200.0, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 330.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 512.21, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1193.19, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1200.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1159.6, "additional_payer_notes": "382.87% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6455) SELF-ADHER BAND >=5/YD - A6455 - 27100098", "code_information": [ { "code": "A6455", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 1.0, "minimum": 1.9339, "maximum": 3.3655, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.99, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2.42, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.93, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3.37, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CATH PLC/COR ANGIO RS/I", "code_information": [ { "code": "93454", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16181.9, "discounted_cash": 3198.0, "minimum": 3198.82, "maximum": 15308.5929, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12602.07, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15308.59, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12247.32, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3486.71, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5409.84, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REMVL PERM PM PLSE GEN W/REPL PLSE GEN SNGL LD", "code_information": [ { "code": "33227", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 32764.1, "discounted_cash": 8165.0, "minimum": 8165.34, "maximum": 32764.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 32168.17, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 32764.1, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 31262.64, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8900.22, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13809.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC US EXTREMITY NON VASCULAR REAL TIME LTD", "code_information": [ { "code": "76882", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 536.56, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 493.645, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 219.91, "10th_percentile": 219.91, "90th_percentile": 261.8, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 207.48, "10th_percentile": 207.48, "90th_percentile": 220.0, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 457.5, "10th_percentile": 457.5, "90th_percentile": 475.73, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 272.03 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 470.8, "10th_percentile": 470.8, "90th_percentile": 470.8, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 478.17, "10th_percentile": 160.02, "90th_percentile": 543.91, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 12-25", "code_information": [ { "code": "87507", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 889.06, "discounted_cash": 416.0, "minimum": 266.718, "maximum": 889.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 506.26, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 405.03, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 889.06 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 454.29, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 704.86, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC TCAT PLMT XTRC VRT CRTD STENT RS&I PRQ 1ST VSL", "code_information": [ { "code": "0075T", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 37173.4, "minimum": 2944.0066, "maximum": 32415.2048, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 2944.01 } ] } ] }, { "description": "HC URINALYSIS NONAUTO W/O SCOPE", "code_information": [ { "code": "81002", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 68.75, "discounted_cash": 3.0, "minimum": 3.3819, "maximum": 59.95, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.48, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3.38, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.26 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.79, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.89, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DIR RPR ANEURYSM AXIL-BRACHIAL ARM INCISION", "code_information": [ { "code": "35011", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11465.6, "discounted_cash": 5490.0, "minimum": 3439.68, "maximum": 11465.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11465.6, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 11465.6, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11465.6, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5984.62, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9285.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Clindamycin Phosphate in D5W IV Soln 600 MG/50ML", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "00781328991", "type": "NDC" }, { "code": "J0736", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 3.4615, "maximum": 3.4615, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.46 } ] } ] }, { "description": "HC EVAL FNA SMEAR TO DETERMIN ADEQUACY, FIRST EVAL", "code_information": [ { "code": "88172", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 160.0, "discounted_cash": 168.0, "minimum": 48.0, "maximum": 160.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 160.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 160.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 160.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 87.76, "10th_percentile": 87.76, "90th_percentile": 87.76, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 140.83 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 160.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 160.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 160.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 160.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 160.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 160.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4452) WATERPROOF TAPE - A4452 - 27100056", "code_information": [ { "code": "A4452", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC OFFICE/OUTPATIENT NEW SF MDM 15-29 MINUTES - G0463 - 76100002", "code_information": [ { "code": "G0463", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 175.63, "discounted_cash": 131.0, "minimum": 41.25, "maximum": 356.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 175.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.18, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 175.63, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 175.63, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 175.63, "additional_payer_notes": "478.57% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF PREALBUMIN", "code_information": [ { "code": "84134", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 130.31, "discounted_cash": 14.0, "minimum": 14.1786, "maximum": 113.6303, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 70.06, "10th_percentile": 70.06, "90th_percentile": 83.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.72, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 71.47, "10th_percentile": 70.13, "90th_percentile": 71.47, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 76.56 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 65.22, "10th_percentile": 65.22, "90th_percentile": 65.22, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.9, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 90.91, "10th_percentile": 90.91, "90th_percentile": 90.91, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.67, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INJ ANTEGRADE NEPHROSTOGRAM/URETEROGRM, EXSIT ACCESS", "code_information": [ { "code": "50431", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2351.88, "discounted_cash": 688.0, "minimum": 688.02, "maximum": 2351.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2351.88, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2351.88, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2351.88, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 749.94, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 688.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1163.58, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL C9364) PORCINE IMPLANT, PERMACOL", "code_information": [ { "code": "C9364", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 39.5385, "maximum": 39.5385, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.54 } ] } ] }, { "description": "HC IMMUNODIFFUSION", "code_information": [ { "code": "86329", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 117.5, "discounted_cash": 14.0, "minimum": 13.6538, "maximum": 102.46, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.05, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.07, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13.65, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 73.72 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 14.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 14.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.76, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MAJOR ESOPHAGEAL DISORDERS WITH CC", "code_information": [ { "code": "369", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8654.0, "minimum": 7043.15, "maximum": 24572.3738, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8347.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 18073.45 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8347.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8347.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 15921.89 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8654.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7043.15 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8654.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15921.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8347.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8654.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8347.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11123.9 } ] } ] }, { "description": "HC BLOOD VISCOSITY EXAMINATION", "code_information": [ { "code": "85810", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 180.63, "discounted_cash": 11.0, "minimum": 11.3409, "maximum": 157.5094, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.67, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.34, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 61.23 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.72, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6229) GAUZE >16<=48 SQ IN WATR/SAL", "code_information": [ { "code": "A6229", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 5.0, "minimum": 4.9853, "maximum": 8.6759, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.13, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.23, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.99, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.59, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.68, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Fluconazole in NaCl 0.9% Inj 200 MG/100ML", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "25021018482", "type": "NDC" }, { "code": "J1450", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 7.697, "maximum": 7.697, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.7 } ] } ] }, { "description": "OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CCMCC", "code_information": [ { "code": "804", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11360.0, "minimum": 7652.22, "maximum": 41213.2488, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10943.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 24502.7 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10943.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10943.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 29675.26 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 11360.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7652.22 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11360.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 29675.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10943.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 11360.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10943.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15081.0 } ] } ] }, { "description": "HC (SUP SHELL A4391) URINARY POUCH W EX WEAR BARR", "code_information": [ { "code": "A4391", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 10.0, "minimum": 9.786, "maximum": 17.0304, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10.07, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.23, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9.79, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 10.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 10.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.98, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 10.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC US EXAM SPINAL CANAL", "code_information": [ { "code": "76800", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 796.56, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 796.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 796.56 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC TREAT BURN 1ST DEGREE, INITIAL", "code_information": [ { "code": "16000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 330.63, "discounted_cash": 197.0, "minimum": 99.189, "maximum": 330.63, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 330.63, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 330.63, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 330.63, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 330.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 215.79, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC", "code_information": [ { "code": "167", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14763.0, "minimum": 12646.65, "maximum": 54188.904, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14208.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 32587.15 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14208.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14208.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 36537.35 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14763.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12646.65 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14763.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 36537.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 54188.9, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 17055.49, "10th_percentile": 17055.49, "90th_percentile": 17055.49, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14208.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 14763.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14208.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20056.84 } ] } ] }, { "description": "HC REMV TRANSVEN PACER ELECTRODE SINGLE LEAD", "code_information": [ { "code": "33234", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7560.31, "discounted_cash": 3687.0, "minimum": 2268.093, "maximum": 7560.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7560.31, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7560.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7560.31, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4019.11, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6235.89, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Vasopressin IV Soln 20 Unit/ML (For IV Infusion)", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "63323093000", "type": "NDC" }, { "code": "J2598", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 3.053, "maximum": 3.053, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.05 } ] } ] }, { "description": "Penicillin G Benzathin Intramuscular Susp 2400000 un", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "60793070102", "type": "NDC" }, { "code": "J0561", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 31.0, "minimum": 29.1637, "maximum": 123.9595, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 123.96, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 36.45, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 29.16, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 58.01 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 31.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 31.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.3, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 31.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 31.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC US,PREGNANT UTERUS,TRANSVAGINAL", "code_information": [ { "code": "76817", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 699.06, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 609.5803, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 354.48, "10th_percentile": 354.48, "90th_percentile": 354.48, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 334.44, "10th_percentile": 334.44, "90th_percentile": 334.44, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 410.08, "10th_percentile": 410.08, "90th_percentile": 426.54, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 503.12 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 235.79, "10th_percentile": 222.7, "90th_percentile": 422.0, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 487.66, "10th_percentile": 464.2, "90th_percentile": 487.67, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Multiple Level Spinal Fusion Except Cervical without MCC", "code_information": [ { "code": "448", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33300.0, "minimum": 28263.25, "maximum": 103549.2065, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 31996.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 76630.58 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 31996.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 31996.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 90905.96 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 33300.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28263.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33300.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 90906.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 31996.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 33300.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 31996.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 47164.82 } ] } ] }, { "description": "HC VIRUS, NOT SPECIFIED", "code_information": [ { "code": "86790", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 130.63, "discounted_cash": 12.0, "minimum": 12.5168, "maximum": 113.9094, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.65, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.52, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 67.58 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 57.57, "10th_percentile": 57.57, "90th_percentile": 57.57, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 67.58, "10th_percentile": 67.58, "90th_percentile": 67.58, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.78, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6233) HYDROGEL DRESSING >48 SQ IN", "code_information": [ { "code": "A6233", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 27.0, "minimum": 26.5593, "maximum": 46.2205, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 27.33, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 33.2, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 26.56, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 27.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 27.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.79, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 27.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 27.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 46.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CT HEART W/O CONTRAST QUANT EVAL CORONARY CALCIUM", "code_information": [ { "code": "75571", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 316.25, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 316.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 238.75, "10th_percentile": 238.75, "90th_percentile": 253.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 316.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 316.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 316.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 316.25 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 192.96, "10th_percentile": 192.96, "90th_percentile": 192.96, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 316.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MICROSCOPIC EXAM OF URINE", "code_information": [ { "code": "81015", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 44.06, "discounted_cash": 3.0, "minimum": 2.964, "maximum": 38.4203, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.05, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.7, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2.96, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.32, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC", "code_information": [ { "code": "094", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 27814.0, "minimum": 25253.86, "maximum": 84708.4983, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 26731.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 63594.99 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 26731.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 26731.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 79122.35 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 27814.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25253.86 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 27814.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 79122.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 26731.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 27814.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 26731.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 39141.64 } ] } ] }, { "description": "HC ASSAY OF PHENOTHIAZINE - G0480 - 30100385", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 225.94, "discounted_cash": 114.0, "minimum": 34.218, "maximum": 1015.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 254.02, "10th_percentile": 72.91, "90th_percentile": 807.41, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 139.0, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 111.2, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 156.38, "10th_percentile": 156.38, "90th_percentile": 171.03, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 823.75, "10th_percentile": 177.26, "90th_percentile": 856.52, "count": "28" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 225.94 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 206.85, "10th_percentile": 206.85, "90th_percentile": 470.25, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 124.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 229.77, "10th_percentile": 218.68, "90th_percentile": 917.78, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 193.52, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L2830) SOFT INTERFACE ABOVE KNEE SE", "code_information": [ { "code": "L2830", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 143.0, "minimum": 139.8809, "maximum": 243.4313, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 143.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 143.94, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 174.84, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 143.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 139.88, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 143.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 143.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 143.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 156.89, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 143.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 143.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 143.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 143.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 143.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 243.43, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DUPLEX SCAN EXTRACRANIAL,LIMITED", "code_information": [ { "code": "93882", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 943.44, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 822.6797, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PHYS THRP EVAL, HIGH COMPLEXITY, 45 MIN", "code_information": [ { "code": "97163", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 525.94, "discounted_cash": 94.0, "minimum": 91.4172, "maximum": 458.6197, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 94.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 94.07, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 114.27, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 94.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 91.42, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 94.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 94.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 94.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 102.54, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 94.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 94.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 94.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 94.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 94.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 159.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DIAGNOSTIC BONE MARROW BIOPSIES & ASPIRATIONS", "code_information": [ { "code": "38222", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 571.56, "discounted_cash": 2866.0, "minimum": 171.468, "maximum": 571.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 344.92, "10th_percentile": 344.92, "90th_percentile": 344.92, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 571.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 571.56, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 571.56, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 571.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 571.56, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 571.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 571.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 571.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 571.56, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 571.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 571.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 571.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 571.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 571.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 571.56, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF CERULOPLASMIN", "code_information": [ { "code": "82390", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 158.44, "discounted_cash": 10.0, "minimum": 10.4371, "maximum": 138.1597, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 48.01, "10th_percentile": 48.01, "90th_percentile": 48.01, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.05, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 10.44, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 80.74, "10th_percentile": 80.74, "90th_percentile": 80.74, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 85.26, "10th_percentile": 85.26, "90th_percentile": 85.26, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 56.35 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.71, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 56.35, "10th_percentile": 10.74, "90th_percentile": 111.54, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.16, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REPR WND INTRMD FACE <2.5 CM", "code_information": [ { "code": "12051", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 698.44, "discounted_cash": 401.0, "minimum": 209.532, "maximum": 698.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 437.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 678.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MRI UPPER EXTREMITY W/O CONTRAST", "code_information": [ { "code": "73218", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2335.94, "discounted_cash": 235.0, "minimum": 235.42, "maximum": 2182.0753, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 927.46, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1126.65, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 901.35, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2182.08 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 256.61, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Lidocaine HCl Local Inj 1%", "drug_information": { "unit": 20.0, "type": "ML" }, "code_information": [ { "code": "00409427616", "type": "NDC" }, { "code": "J2003", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 11.99, "10th_percentile": 11.99, "90th_percentile": 12.71, "count": "14" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 14.84, "10th_percentile": 14.13, "90th_percentile": 25.07, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 15.7, "10th_percentile": 15.7, "90th_percentile": 15.7, "count": "1 through 10" } ] } ] }, { "description": "HC ANTIHUMAN GLOBULIN DIR EA ANTISERUM", "code_information": [ { "code": "86880", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 105.63, "discounted_cash": 58.0, "minimum": 28.2824, "maximum": 105.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 24.09, "10th_percentile": 24.09, "90th_percentile": 24.09, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 105.63, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 105.63, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 105.63, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.28 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.44, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 98.43, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY JAW 4+ VW", "code_information": [ { "code": "70110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 660.63, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 576.0694, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 280.82 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L0130) FLEX THERMOPLASTIC COLLAR MO", "code_information": [ { "code": "L0130", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 195.0, "minimum": 190.1424, "maximum": 330.9002, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 195.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 195.66, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 237.67, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 195.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 190.14, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 195.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 195.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 195.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 213.27, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 195.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 195.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 195.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 195.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 195.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 330.9, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC LARYNGOSCOPY FLEX DIAG", "code_information": [ { "code": "31575", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 615.31, "discounted_cash": 196.0, "minimum": 184.593, "maximum": 615.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 615.31, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 615.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 615.31, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 214.68, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 333.08, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MYELIN BASIC PROTEIN,CSF", "code_information": [ { "code": "83873", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 286.88, "discounted_cash": 17.0, "minimum": 16.715, "maximum": 250.1594, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.2, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.89, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 16.71, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 90.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 17.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 17.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.75, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 17.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAYS, BONE LENGTH STUDIES", "code_information": [ { "code": "77073", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 919.38, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 801.6994, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 283.72 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC EHRLICHIA, ANTIBODY", "code_information": [ { "code": "86666", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 217.81, "discounted_cash": 10.0, "minimum": 9.8929, "maximum": 189.9303, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.37, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 53.42 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.1, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 144.76, "10th_percentile": 144.76, "90th_percentile": 394.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MEDICAL BACK PROBLEMS WITHOUT MCC", "code_information": [ { "code": "552", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8359.0, "minimum": 6670.78, "maximum": 23208.2405, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8063.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 17370.54 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8063.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8063.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 14115.78 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8359.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6670.78 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8359.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14115.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8063.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8359.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8063.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10691.27 } ] } ] }, { "description": "HC EX FOR SPEECH DEVICE RX INIT HR", "code_information": [ { "code": "92607", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 638.13, "discounted_cash": 117.0, "minimum": 95.0, "maximum": 556.4494, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 117.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 117.31, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 142.5, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 117.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 114.0, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 117.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 117.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 117.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 127.87, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 117.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 117.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 117.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 117.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 117.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 198.39, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CNS DNA/RNA AMP PROBE MULTIPLE SUBTYPES 12-25", "code_information": [ { "code": "87483", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 889.06, "discounted_cash": 416.0, "minimum": 266.718, "maximum": 889.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 506.26, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 405.03, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 889.06 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 711.25, "10th_percentile": 711.25, "90th_percentile": 711.25, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 454.29, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 704.86, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS", "code_information": [ { "code": "019", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 55309.0, "minimum": 53114.4, "maximum": 154297.37, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 53114.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 128921.08 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 53114.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 53114.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 154297.37 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 55309.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 54867.46 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 55309.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 154297.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 53114.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 55309.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 53114.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 79348.74 } ] } ] }, { "description": "ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITHOUT MCC", "code_information": [ { "code": "279", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 28476.0, "minimum": 22178.71, "maximum": 72359.9639, "payers_information": [ { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 27366.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 40109.23 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 27366.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 65167.07 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 27366.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 27366.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 47021.39 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 28476.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22178.71 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 28476.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 47021.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 27366.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 28476.0, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC", "code_information": [ { "code": "543", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8866.0, "minimum": 7342.84, "maximum": 25616.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8550.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 18575.8 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8550.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8550.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 25616.87 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8866.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7342.84 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8866.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25616.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8550.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8866.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8550.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11433.09 } ] } ] }, { "description": "HC OCCULT BLOOD OTHER SOURCES", "code_information": [ { "code": "82271", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 61.88, "discounted_cash": 5.0, "minimum": 5.17, "maximum": 53.9594, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.46, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.17, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.92 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.8, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL C1782) MORCELLATOR", "code_information": [ { "code": "C1782", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 1768.16, "10th_percentile": 1768.16, "90th_percentile": 2831.25, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL A4355) BLADDER IRRIGATION TUBING", "code_information": [ { "code": "A4355", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 10.0, "minimum": 10.4954, "maximum": 18.265, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.12, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.77, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.26, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER KIDNEY AND URINARY TRACT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "675", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13531.0, "minimum": 10833.96, "maximum": 41390.2997, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13026.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 29659.84 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13026.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13026.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 32995.25 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 13531.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10833.96 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13531.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32995.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13026.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 13531.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13026.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18255.13 } ] } ] }, { "description": "Aminophylline Inj 25 MG/ML", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "00409592116", "type": "NDC" }, { "code": "J0280", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 23.7575, "maximum": 23.7575, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.76 } ] } ] }, { "description": "HC ASSAY OF PYRUVATE", "code_information": [ { "code": "84210", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 372.19, "discounted_cash": 14.0, "minimum": 14.0717, "maximum": 324.5497, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.59, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.07, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 75.98 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.49, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6452) HIGH COMPRES BAND W>=3<5YD - A6452 - 27100095", "code_information": [ { "code": "A6452", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 8.0, "minimum": 8.1631, "maximum": 14.2061, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.2, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8.16, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.16, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT", "code_information": [ { "code": "20604", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1364.38, "discounted_cash": 302.0, "minimum": 302.87, "maximum": 1364.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1193.19, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1364.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1159.6, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 330.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 512.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY FOR PANCREAS ENDOSCOPY", "code_information": [ { "code": "74329", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2509.38, "minimum": 374.4, "maximum": 2188.1794, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 374.4 } ] } ] }, { "description": "HC OFFICE/OUTPATIENT ESTABLISHED MINIMAL PROBLEM(S) - G0463 - 76100006", "code_information": [ { "code": "G0463", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 137.5, "discounted_cash": 131.0, "minimum": 41.25, "maximum": 356.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 137.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 137.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 137.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.5, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 137.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF VITAMIN B-2", "code_information": [ { "code": "84252", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 469.38, "discounted_cash": 20.0, "minimum": 19.6692, "maximum": 409.2994, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 90.47, "10th_percentile": 90.47, "90th_percentile": 90.47, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.59, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 19.67, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 106.2 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.06, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 327.44, "10th_percentile": 327.44, "90th_percentile": 327.44, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.23, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITH MCC OR 4+ ARTERIESINTRALUMINAL DEVICES", "code_information": [ { "code": "321", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21740.0, "minimum": 19703.64, "maximum": 85880.6605, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 77312.29, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 79134.07, "10th_percentile": 79134.07, "90th_percentile": 79134.07, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 20903.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 49164.42 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 20903.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 20903.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 56426.07 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 21740.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19703.64 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21740.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 56426.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 20903.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 21740.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 20903.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30259.87 } ] } ] }, { "description": "HC STRAPPING OF ANKLE AND/OR FT", "code_information": [ { "code": "29540", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 342.5, "discounted_cash": 160.0, "minimum": 102.75, "maximum": 342.5, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 271.15, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 342.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 342.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 342.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 174.76, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.33, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC US, RETROPERITNL ABD, LTD", "code_information": [ { "code": "76775", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 677.81, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 591.0503, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 560.4, "10th_percentile": 560.4, "90th_percentile": 560.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 470.75, "10th_percentile": 470.75, "90th_percentile": 470.75, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 566.3, "10th_percentile": 544.57, "90th_percentile": 566.3, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 286.63 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 131.64, "10th_percentile": 131.64, "90th_percentile": 131.64, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 647.46, "10th_percentile": 647.46, "90th_percentile": 647.46, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC TEAEC W/WO PATCH GRAFT ILIAC", "code_information": [ { "code": "35351", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12129.4, "minimum": 3638.82, "maximum": 12129.4, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 12129.4 } ] } ] }, { "description": "HC (SUP SHELL A4624) TRACHEAL SUCTION TUBE - A4624 - 27200092", "code_information": [ { "code": "A4624", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 3.0, "minimum": 3.1098, "maximum": 5.4118, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.2, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.89, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3.11, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.49, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.41, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Nafcillin Sodium For Inj 2 GM", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "55150012315", "type": "NDC" }, { "code": "J2290", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "Argatroban Inj 250 MG/2.5ML (Concentrate For IV Infusion)", "drug_information": { "unit": 3.0, "type": "ML" }, "code_information": [ { "code": "00143967401", "type": "NDC" }, { "code": "J0883", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 1.0, "minimum": 1.0, "maximum": 3.9908, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.99, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2.04 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.1, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1.71, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC UNLISTED RESPIRATORY PX DX NUCLEAR MEDICINE", "code_information": [ { "code": "78599", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1130.63, "discounted_cash": 394.0, "minimum": 339.189, "maximum": 1130.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1130.63, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1130.63, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1130.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC FLOWCYTOMETRY/ TECH COMPONENT, 1 MARKER", "code_information": [ { "code": "88184", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 270.31, "discounted_cash": 353.0, "minimum": 81.093, "maximum": 270.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 252.75, "10th_percentile": 252.75, "90th_percentile": 252.75, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 270.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 270.31, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 270.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 270.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 270.31, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 170.02, "10th_percentile": 170.02, "90th_percentile": 173.29, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 270.31 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 270.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 270.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 270.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 270.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 270.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 270.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 222.42, "10th_percentile": 220.4, "90th_percentile": 506.09, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 270.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 270.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 270.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 270.31, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REPR WND SMP BODY/SCALP/EXTR 12.6-20 CM", "code_information": [ { "code": "12005", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 583.44, "discounted_cash": 401.0, "minimum": 175.032, "maximum": 583.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 583.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 583.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 583.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 437.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 583.44, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INSITU HYBRIDIZE, PER SPCMN, EA ADD SPCMN SINGL PROB STAIN", "code_information": [ { "code": "88364", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 400.0, "minimum": 120.0, "maximum": 400.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 400.0 } ] } ] }, { "description": "HC RO SET RADN THERAPY FIELD INTERME", "code_information": [ { "code": "77285", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1691.56, "discounted_cash": 369.0, "minimum": 369.45, "maximum": 1691.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 369.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1455.49, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1691.56, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 369.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1414.51, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 369.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 369.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 369.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 402.7, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 369.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 369.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 369.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 369.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 369.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 624.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REMV PERM PACER GENERATOR", "code_information": [ { "code": "33233", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7560.31, "discounted_cash": 8165.0, "minimum": 2268.093, "maximum": 7560.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7560.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7560.31, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7560.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7560.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7560.31, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7560.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 7560.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7560.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7560.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7560.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7560.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7560.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 7560.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7560.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7560.31, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REPR WND INTRMD NECK/HND/FT/GENT 7.6-12.5 CM", "code_information": [ { "code": "12044", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 698.44, "discounted_cash": 729.0, "minimum": 209.532, "maximum": 698.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CHEMOTHER, IV PUSH,EA ADD DRUG", "code_information": [ { "code": "96411", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 360.0, "discounted_cash": 71.0, "minimum": 71.04, "maximum": 339.9761, "payers_information": [ { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.14, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 279.87, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 339.98, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 271.99, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.04, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC IGK@ GENE REARRANGE DETECT ABNORMAL CLONAL POP", "code_information": [ { "code": "81264", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 875.0, "discounted_cash": 172.0, "minimum": 167.859, "maximum": 875.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 172.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 172.73, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 209.82, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 172.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 167.86, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 875.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 172.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 172.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 172.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 172.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 172.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 172.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 172.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 172.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 292.12, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CHROMOSOME ANALY:AMNIOTIC", "code_information": [ { "code": "88269", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 922.81, "discounted_cash": 173.0, "minimum": 168.7628, "maximum": 911.2288, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 173.66, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 210.94, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 168.76, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 911.23 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 173.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 173.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 189.29, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 173.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 293.69, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY PELVIS 1/2 VW", "code_information": [ { "code": "72170", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 724.69, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 631.9297, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 225.12, "10th_percentile": 225.12, "90th_percentile": 225.12, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 36.37, "10th_percentile": 36.37, "90th_percentile": 36.37, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 270.76, "10th_percentile": 260.43, "90th_percentile": 270.76, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 172.57 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 77.51, "10th_percentile": 77.51, "90th_percentile": 77.51, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 309.56, "10th_percentile": 272.14, "90th_percentile": 505.54, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REMV F.B.,EYE,CORNEA,NO SLIT", "code_information": [ { "code": "65220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 458.75, "discounted_cash": 440.0, "minimum": 137.625, "maximum": 458.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 458.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 458.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 458.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 458.75, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 458.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REVASC LITH-STEN-ATH TIB/PER", "code_information": [ { "code": "C9775", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 71019.1, "discounted_cash": 18087.0, "minimum": 18087.87, "maximum": 71019.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 71019.1, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 71019.1, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 69253.03, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19715.78, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30590.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CYTOMED, DNA, AMP PROBE", "code_information": [ { "code": "87493", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 244.69, "discounted_cash": 37.0, "minimum": 36.219, "maximum": 213.3697, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 124.15, "10th_percentile": 124.15, "90th_percentile": 147.8, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 37.27, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 45.27, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 36.22, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 131.68, "10th_percentile": 131.68, "90th_percentile": 131.68, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 195.56 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 37.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 166.6, "10th_percentile": 166.6, "90th_percentile": 166.6, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 37.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.62, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 37.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 162.58, "10th_percentile": 162.58, "90th_percentile": 170.69, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 37.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 63.03, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITH CC", "code_information": [ { "code": "289", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14029.0, "minimum": 10912.86, "maximum": 36915.32, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13504.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 30843.41 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13504.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13504.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 36915.32 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14029.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10912.86 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14029.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 36915.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 28555.03, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 9119.18, "10th_percentile": 9119.18, "90th_percentile": 33657.45, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13504.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 14029.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13504.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18983.6 } ] } ] }, { "description": "HC (SUP SHELL Q4042) CAST SUP LNG LEG SPLNT FBRGL", "code_information": [ { "code": "Q4042", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 43.0, "minimum": 42.2636, "maximum": 73.5503, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 43.49, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 52.83, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 42.26, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 43.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 43.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 43.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 43.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 73.55, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "145", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10192.0, "minimum": 8200.39, "maximum": 21725.3686, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9822.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 21725.37 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9822.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9822.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 9718.35 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 10192.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8200.39 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10192.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9718.35 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9822.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 10192.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9822.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13371.6 } ] } ] }, { "description": "AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC", "code_information": [ { "code": "239", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 38479.0, "minimum": 34862.05, "maximum": 104989.1394, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 36965.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 88934.33 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 36965.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 36965.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 96844.52 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 38479.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34862.05 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 38479.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 96844.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 36965.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 38479.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 36965.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 54737.57 } ] } ] }, { "description": "HC ALPHA-1-ANTITRYPSIN, PHENO", "code_information": [ { "code": "82104", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 362.19, "discounted_cash": 14.0, "minimum": 14.0522, "maximum": 315.8297, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 64.64, "10th_percentile": 64.64, "90th_percentile": 64.64, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.56, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.05, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 184.57, "10th_percentile": 184.57, "90th_percentile": 184.57, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 194.91, "10th_percentile": 194.91, "90th_percentile": 194.91, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 75.87 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.76, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 252.66, "10th_percentile": 252.66, "90th_percentile": 252.66, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC", "code_information": [ { "code": "659", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20372.0, "minimum": 17886.79, "maximum": 51123.8377, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 19590.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 45913.66 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 19590.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 19590.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 34577.31 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 20372.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17886.79 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20372.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 34577.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 51123.84, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 27150.1, "10th_percentile": 27150.1, "90th_percentile": 27150.1, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 19590.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 20372.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 19590.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28259.08 } ] } ] }, { "description": "HC (SUP SHELL C1874) STENT COATED/COVR W/DELIVERY SYSTEM", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1161.59, "10th_percentile": 1161.59, "90th_percentile": 1161.59, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 2656.11, "10th_percentile": 2656.11, "90th_percentile": 22398.63, "count": "1 through 10" } ] } ] }, { "description": "Enoxaparin Sodium Inj Soln Pref Syr 120 MG/0.8ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00548560600", "type": "NDC" }, { "code": "J1650", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.118, "maximum": 1.118, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 35.37, "10th_percentile": 35.37, "90th_percentile": 35.37, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.12 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 41.68, "10th_percentile": 41.68, "90th_percentile": 43.54, "count": "1 through 10" } ] } ] }, { "description": "OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC", "code_information": [ { "code": "580", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14190.0, "minimum": 12271.52, "maximum": 43551.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13658.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 31224.68 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13658.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13658.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 43551.4 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14190.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12271.52 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14190.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 43551.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13658.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 14190.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13658.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19218.26 } ] } ] }, { "description": "ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY", "code_information": [ { "code": "770", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8673.0, "minimum": 7447.35, "maximum": 19949.895, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8365.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 18118.63 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8365.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8365.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 17451.34 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8673.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7447.35 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8673.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17451.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8365.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8673.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8365.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11151.71 } ] } ] }, { "description": "HC X-RAY SINUSES <3 VW", "code_information": [ { "code": "70210", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 467.81, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 410.9481, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 410.95, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 210.61 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6266) IMPREG GAUZE NO H20/SAL/YARD - A6266 - RU272007", "code_information": [ { "code": "A6266", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 2.0, "minimum": 2.6433, "maximum": 4.6001, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2.72, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.3, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2.64, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.96, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "GASTROINTESTINAL OBSTRUCTION WITHOUT CCMCC", "code_information": [ { "code": "390", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5185.0, "minimum": 3787.35, "maximum": 12090.2547, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 10884.0, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 6877.12, "10th_percentile": 6877.12, "90th_percentile": 6877.12, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5018.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 9829.99 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 5018.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 10574.81, "standard_charge_algorithm": "76.27% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 4377.1, "10th_percentile": 4377.1, "90th_percentile": 4377.1, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 5018.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 8814.32 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 5185.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3787.35 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5185.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8814.32 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5018.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 5185.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 5018.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6050.19 } ] } ] }, { "description": "HC (SUP SHELL A6240) HYDROCOLLD DRG FILLER PASTE", "code_information": [ { "code": "A6240", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 17.0, "minimum": 16.9579, "maximum": 29.5114, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.45, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.2, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 16.96, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 17.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 17.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.02, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 17.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.51, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC OFFICE/OUTPATIENT ESTABLISHED HIGH MDM 40-54 MIN - G0463 - 76100010", "code_information": [ { "code": "G0463", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 334.69, "discounted_cash": 131.0, "minimum": 41.25, "maximum": 356.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 334.69, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 334.69, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 334.69, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.18, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 222.16, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC SUPSLCTV CATH 2ND+ORD RENL&ACCES ARTERY/S&I UNI", "code_information": [ { "code": "36253", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9039.06, "discounted_cash": 5490.0, "minimum": 2711.718, "maximum": 9039.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9039.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9039.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9039.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5984.62, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9039.06, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HEART FAILURE AND SHOCK WITH CC", "code_information": [ { "code": "292", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7505.0, "minimum": 5960.65, "maximum": 20419.3057, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7243.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 15341.29 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7243.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7243.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 12266.79 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7505.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5960.65 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7505.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12266.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7243.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7505.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7243.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9442.31 } ] } ] }, { "description": "HC (SUP SHELL A6257) TRANSPARENT FILM <= 16 SQ IN - A6257 - 27200146", "code_information": [ { "code": "A6257", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 2.0, "minimum": 2.1185, "maximum": 3.6868, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2.18, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2.65, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2.12, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.38, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3.69, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC", "code_information": [ { "code": "025", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 35627.0, "minimum": 30954.26, "maximum": 82417.02, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 34228.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 82158.14 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 34228.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 34228.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 82417.02 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 35627.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30954.26 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 35627.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 82417.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 34228.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 35627.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 34228.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 50566.94 } ] } ] }, { "description": "HC GLUCOSE BLOOD TEST", "code_information": [ { "code": "82962", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 37.5, "discounted_cash": 3.0, "minimum": 3.1875, "maximum": 32.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.98, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3.19, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.21 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.58, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.55, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Methylprednisolone Sod Succ For Inj PF 40 MG (Base Equiv)", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00009003930", "type": "NDC" }, { "code": "J2919", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 43.31, "10th_percentile": 43.31, "90th_percentile": 159.45, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 51.04, "10th_percentile": 51.04, "90th_percentile": 53.33, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 12.5, "10th_percentile": 12.5, "90th_percentile": 12.5, "count": "1 through 10" } ] } ] }, { "description": "HC METABOLIC PANEL,COMPREHENSIVE", "code_information": [ { "code": "80053", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 336.88, "discounted_cash": 10.0, "minimum": 10.2622, "maximum": 293.7594, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 203.4, "10th_percentile": 170.86, "90th_percentile": 203.4, "count": "354" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.83, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medigap", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.59, "median_amount": 12.83, "10th_percentile": 12.83, "90th_percentile": 12.83, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 10.26, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 171.67, "10th_percentile": 161.96, "90th_percentile": 235.0, "count": "11" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 174.31, "10th_percentile": 174.31, "90th_percentile": 181.29, "count": "640" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 55.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 47.2, "10th_percentile": 47.2, "90th_percentile": 203.4, "count": "197" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.51, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 223.74, "10th_percentile": 55.41, "90th_percentile": 235.0, "count": "12" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.86, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR", "code_information": [ { "code": "81229", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2755.0, "discounted_cash": 1160.0, "minimum": 826.5, "maximum": 2755.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1160.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1160.0, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1409.05, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1160.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1127.29, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2755.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1160.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1160.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1160.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1264.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1160.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1160.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1160.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1160.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1160.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1961.79, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MAJOR SKIN DISORDERS WITH MCC", "code_information": [ { "code": "595", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17176.0, "minimum": 14639.31, "maximum": 38320.7097, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16524.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 38320.71 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 16524.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 16524.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 28703.04 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 17176.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14639.31 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17176.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 28703.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16524.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 17176.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16524.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23585.75 } ] } ] }, { "description": "HC PERQ SFT TISS LOC DEVICE PLMT 1ST LES W/GDNCE", "code_information": [ { "code": "10035", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1114.69, "discounted_cash": 698.0, "minimum": 334.407, "maximum": 1114.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 700.02, "10th_percentile": 700.02, "90th_percentile": 700.02, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1114.69, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1114.69, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1114.69, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 761.59, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1114.69, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INJ, THERAP/PROPH/DIAGN, IV PUSH INIT DX", "code_information": [ { "code": "96374", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 633.13, "discounted_cash": 209.0, "minimum": 189.939, "maximum": 633.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 340.37, "10th_percentile": 340.37, "90th_percentile": 405.2, "count": "34" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 633.13, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 633.13, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 633.13, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.3, "median_amount": 374.24, "10th_percentile": 374.24, "90th_percentile": 441.67, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 397.6, "10th_percentile": 313.8, "90th_percentile": 401.15, "count": "16" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 228.76, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 441.67, "10th_percentile": 441.67, "90th_percentile": 445.72, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 354.93, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CHEMODNRVTJ MUSC MUSC INNERVATED FACIAL NRV UNIL", "code_information": [ { "code": "64612", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 983.13, "discounted_cash": 302.0, "minimum": 294.939, "maximum": 983.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 983.13, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 983.13, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 983.13, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 330.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 512.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM, EA AG", "code_information": [ { "code": "86902", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 242.5, "discounted_cash": 353.0, "minimum": 33.3197, "maximum": 242.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 242.5, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 242.5, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 242.5, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.32 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 242.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 242.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 242.5, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 242.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 242.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 242.5, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 242.5, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC", "code_information": [ { "code": "327", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19637.0, "minimum": 16805.68, "maximum": 58565.35, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18885.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 44166.3 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 18885.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 18885.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 58565.35 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 19637.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16805.68 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19637.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 58565.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18885.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 19637.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18885.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27183.61 } ] } ] }, { "description": "HC SPECIMEN CONCENTRAT, INFECT AGENTS", "code_information": [ { "code": "87015", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 104.38, "discounted_cash": 6.0, "minimum": 6.4916, "maximum": 91.0194, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.11, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6.49, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 53.99, "10th_percentile": 53.99, "90th_percentile": 53.99, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.05 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 34.94, "10th_percentile": 34.94, "90th_percentile": 34.94, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.3, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INSERT TUNNEL INTRAPERITONEAL CATH W IMG GUIDE", "code_information": [ { "code": "49418", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4036.56, "discounted_cash": 3532.0, "minimum": 1210.968, "maximum": 4036.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4036.56, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4036.56, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4036.56, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3850.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4036.56, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4216) STERILE WATER/SALINE, 10 ML", "code_information": [ { "code": "A4216", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0655, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1.07, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "COMPLICATIONS OF TREATMENT WITHOUT CCMCC", "code_information": [ { "code": "921", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6283.0, "minimum": 4759.8, "maximum": 12439.2779, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6071.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 12439.28 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6071.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6071.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 8874.72 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6283.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4759.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6283.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8874.72 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6071.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 6283.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6071.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7656.16 } ] } ] }, { "description": "HC COMPLEMENT/FUNCTION ACTIVITY", "code_information": [ { "code": "86161", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 255.0, "discounted_cash": 12.0, "minimum": 11.6616, "maximum": 222.36, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.58, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.66, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 62.97 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.08, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.29, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Glycopyrrolate Inj 0.4 MG/2ML (0.2 MG/ML)", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "70700016622", "type": "NDC" }, { "code": "J1596", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0965, "maximum": 1.0965, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.1 } ] } ] }, { "description": "HC EVASC RPR DPLMNT ILIO-ILIAC NDGFT RPT", "code_information": [ { "code": "34708", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7389.06, "minimum": 2216.718, "maximum": 7389.06, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 7389.06 } ] } ] }, { "description": "HC EPHYS EVAL W ABLATION SUPRAVENT ARRHYTHMIA", "code_information": [ { "code": "93653", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 60116.9, "discounted_cash": 25790.0, "minimum": 18035.07, "maximum": 60116.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25790.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 60116.9, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 60116.9, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25790.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 60116.9, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25790.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 25790.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 25790.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28111.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25790.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25790.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25790.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 25790.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25790.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43616.56, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC BAMLANIVIMAB AND ETESEVIMAB INFUSION AND MONITORING", "code_information": [ { "code": "M0245", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 658.44, "discounted_cash": 435.0, "minimum": 197.532, "maximum": 658.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 435.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 658.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 658.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 435.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 658.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 435.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 435.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 435.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 474.24, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 435.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 435.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 435.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 435.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 435.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 658.44, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MAJOR HEAD AND NECK PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "142", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13189.0, "minimum": 10883.1, "maximum": 32334.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12698.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 28846.69 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12698.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12698.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 32334.76 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 13189.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10883.1 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13189.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32334.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12698.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 13189.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12698.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17754.65 } ] } ] }, { "description": "HC INTERROGATION EVAL IN PERSON WR DEFIBRILLATOR", "code_information": [ { "code": "93292", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 320.31, "discounted_cash": 36.0, "minimum": 36.82, "maximum": 279.3103, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 145.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 176.21, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 140.97, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.27, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC COMMUNITY/WORK REINTEGRATION COMPLX EA 15 MIN", "code_information": [ { "code": "97537", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 113.44, "discounted_cash": 30.0, "minimum": 29.8148, "maximum": 98.9197, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 37.27, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 29.81, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 30.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 30.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.44, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 30.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 30.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 51.89, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 30.68, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" } ] } ] }, { "description": "HC FLUORSCOPIC GUIDANCE SPINAL INJECTION", "code_information": [ { "code": "77003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 660.94, "minimum": 198.282, "maximum": 660.94, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 660.94 } ] } ] }, { "description": "KIDNEY TRANSPLANT", "code_information": [ { "code": "652", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 25609.0, "minimum": 21258.17, "maximum": 71093.22, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24616.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 58356.55 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 24616.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24616.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 71093.22 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 25609.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21258.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 25609.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 71093.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24616.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 25609.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 24616.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 35917.47 } ] } ] }, { "description": "HC MED NUTR THER, SUBSQ, INDIV, EA 15 MIN", "code_information": [ { "code": "97803", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 75.63, "discounted_cash": 21.0, "minimum": 20.7771, "maximum": 65.9494, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 21.38, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.97, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 20.78, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 21.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 21.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.3, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 21.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.16, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC", "code_information": [ { "code": "808", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17839.0, "minimum": 15851.92, "maximum": 49817.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17160.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 39896.4 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 17160.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 17160.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 49817.28 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 17839.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15851.92 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17839.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 49817.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17160.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 17839.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17160.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24555.56 } ] } ] }, { "description": "REHABILITATION WITH CCMCC", "code_information": [ { "code": "945", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12825.0, "minimum": 10565.41, "maximum": 33490.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12349.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 27982.95 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12349.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12349.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 33490.13 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12825.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10565.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12825.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 33490.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12349.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 12825.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12349.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17223.03 } ] } ] }, { "description": "OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "423", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 32633.0, "minimum": 28151.82, "maximum": 218868.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 31355.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 75044.05 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 31355.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 31355.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 218867.53 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 32633.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28151.82 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 32633.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 218868.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 31355.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 32633.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 31355.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 46188.34 } ] } ] }, { "description": "HC ASSAY OF PROGESTERONE", "code_information": [ { "code": "84144", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 275.31, "discounted_cash": 20.0, "minimum": 20.2717, "maximum": 240.0703, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 148.01, "10th_percentile": 148.01, "90th_percentile": 148.01, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.34, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 20.27, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 140.3, "10th_percentile": 140.3, "90th_percentile": 140.3, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 151.0, "10th_percentile": 151.0, "90th_percentile": 151.0, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 109.46 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.74, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 192.06, "10th_percentile": 192.06, "90th_percentile": 192.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.28, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DUPLEX LARGE VESSEL(S),COMPLETE", "code_information": [ { "code": "93978", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1845.63, "discounted_cash": 235.0, "minimum": 235.42, "maximum": 1609.3894, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 927.46, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1126.65, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 901.35, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 419.04, "10th_percentile": 419.04, "90th_percentile": 419.04, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 256.61, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Methotrexate Sodium Inj PF 100 MG/4ML (25 MG/ML)", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "00143951901", "type": "NDC" }, { "code": "J9260", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 6.7854, "maximum": 6.7854, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.79 } ] } ] }, { "description": "HC SPECTROPHOTOMETRY", "code_information": [ { "code": "84311", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 198.75, "discounted_cash": 8.0, "minimum": 7.8716, "maximum": 173.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.84, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7.87, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 42.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC", "code_information": [ { "code": "345", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12491.0, "minimum": 10303.78, "maximum": 33663.8303, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12028.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 27189.69 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12028.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 29444.27, "standard_charge_algorithm": "76.27% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 18559.86, "10th_percentile": 18559.86, "90th_percentile": 18559.86, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12028.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 30080.52 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12491.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10303.78 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12491.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 30080.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12028.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 12491.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12028.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16734.79 } ] } ] }, { "description": "HC CLSD TREAT NOSE FX W STABIL", "code_information": [ { "code": "21320", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 784.69, "discounted_cash": 3271.0, "minimum": 235.407, "maximum": 784.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 784.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 784.69, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 784.69, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 784.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 784.69, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 784.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 784.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 784.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 784.69, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 784.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 784.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 784.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 784.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 784.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 784.69, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Caffeine Citrate Inj 60 MG/3ML (10 MG/ML Base Equiv)", "drug_information": { "unit": 3.0, "type": "ML" }, "code_information": [ { "code": "00641616401", "type": "NDC" }, { "code": "J0706", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 3.1175, "maximum": 3.1175, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.12 } ] } ] }, { "description": "HC REMOVE FULL ARM/LEG CAST", "code_information": [ { "code": "29705", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 208.13, "discounted_cash": 275.0, "minimum": 62.439, "maximum": 208.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 208.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 208.13, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 208.13, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 208.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 208.13, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 208.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 208.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 208.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 208.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 208.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 208.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 208.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 208.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 208.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 208.13, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REMOVAL FOOT FB SUBQ", "code_information": [ { "code": "28190", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4403.44, "discounted_cash": 698.0, "minimum": 698.71, "maximum": 3839.7997, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2752.64, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3343.82, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2675.15, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 761.59, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1181.66, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY KNEE 4+ VIEW", "code_information": [ { "code": "73564", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 630.94, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 550.1797, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 320.04, "10th_percentile": 320.04, "90th_percentile": 381.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 480.02, "10th_percentile": 480.02, "90th_percentile": 480.02, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 384.97, "10th_percentile": 384.97, "90th_percentile": 384.97, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 318.86 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 440.14, "10th_percentile": 440.14, "90th_percentile": 1025.9, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Prednisone Tab 20 MG", "drug_information": { "unit": 100.0, "type": "EA" }, "code_information": [ { "code": "59651048801", "type": "NDC" }, { "code": "J7512", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC URINALYSIS, AUTO, W/SCOPE", "code_information": [ { "code": "81001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 72.81, "discounted_cash": 3.0, "minimum": 3.0806, "maximum": 63.4903, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 46.6, "10th_percentile": 39.14, "90th_percentile": 46.6, "count": "65" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.17, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.85, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3.08, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 37.11, "10th_percentile": 37.11, "90th_percentile": 37.11, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 39.94, "10th_percentile": 39.94, "90th_percentile": 39.94, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.63 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 14.17, "10th_percentile": 14.17, "90th_percentile": 46.6, "count": "26" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.46, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 50.79, "10th_percentile": 16.63, "90th_percentile": 50.79, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.36, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MAJOR THUMB OR JOINT PROCEDURES", "code_information": [ { "code": "506", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11309.0, "minimum": 10375.77, "maximum": 29178.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10894.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 24379.83 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10894.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10894.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 29178.44 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 11309.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10375.77 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11309.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 29178.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10894.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 11309.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10894.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15005.37 } ] } ] }, { "description": "HC (SUP SHELL A4338) INDWELLING CATHETER LATEX", "code_information": [ { "code": "A4338", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 17.0, "minimum": 16.9871, "maximum": 29.5622, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.48, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 16.99, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 17.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 17.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.05, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 17.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.56, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC C-REACTIVE PROTEIN", "code_information": [ { "code": "86140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 147.81, "discounted_cash": 5.0, "minimum": 5.0339, "maximum": 128.8903, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 89.2, "10th_percentile": 74.93, "90th_percentile": 89.2, "count": "38" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.29, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.03, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 71.03, "10th_percentile": 71.03, "90th_percentile": 75.33, "count": "30" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 76.44, "10th_percentile": 76.44, "90th_percentile": 79.55, "count": "89" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.18 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 23.15, "10th_percentile": 23.15, "90th_percentile": 74.93, "count": "30" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 98.12, "10th_percentile": 98.12, "90th_percentile": 103.11, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC", "code_information": [ { "code": "981", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 36730.0, "minimum": 32903.31, "maximum": 111949.2231, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 35287.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 84780.08 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 35287.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 35287.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 95342.35 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 36730.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32903.31 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 36730.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 95342.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 35287.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 36730.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 35287.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 52180.7 } ] } ] }, { "description": "PROSTATECTOMY WITH CC", "code_information": [ { "code": "666", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14352.0, "minimum": 11401.51, "maximum": 37831.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13814.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 31609.57 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13814.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13814.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 37831.05 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14352.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11401.51 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14352.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 37831.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13814.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 14352.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13814.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19455.15 } ] } ] }, { "description": "HC ONCOPROTEIN DCP", "code_information": [ { "code": "83951", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 298.13, "discounted_cash": 64.0, "minimum": 62.5936, "maximum": 298.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 78.24, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 62.59, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 298.13 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 70.21, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 108.93, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A5062) DRNBLE OSTOMY POUCH W/O BARR", "code_information": [ { "code": "A5062", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 3.0, "minimum": 3.0903, "maximum": 5.378, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3.09, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.47, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.18, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.86, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L8690) AUD OSSEO DEV, INT/EXT COMP", "code_information": [ { "code": "L8690", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 5717.0, "minimum": 5556.1499, "maximum": 9669.2331, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5717.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5717.38, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6944.9, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5717.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5556.15, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5717.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5717.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5717.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6231.94, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5717.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5717.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5717.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5717.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5717.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9669.23, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PROF SVCS ALLG IMMNTX X W/PRV ALLGIC XTRCS 1 NJX", "code_information": [ { "code": "95115", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 58.44, "discounted_cash": 46.0, "minimum": 17.532, "maximum": 58.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 58.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 58.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 58.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50.36, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 58.44, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DRUG SCREEN QUANT ALCOHOLS BIOMARKERS 1 OR 2 - G0480 - 31080321", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 478.13, "discounted_cash": 114.0, "minimum": 34.218, "maximum": 1015.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 254.02, "10th_percentile": 72.91, "90th_percentile": 807.41, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 139.0, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 111.2, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 156.38, "10th_percentile": 156.38, "90th_percentile": 171.03, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 823.75, "10th_percentile": 177.26, "90th_percentile": 856.52, "count": "28" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 478.13 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 206.85, "10th_percentile": 206.85, "90th_percentile": 470.25, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 124.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 229.77, "10th_percentile": 218.68, "90th_percentile": 917.78, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 193.52, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L0172) CERV COL SR FOAM 2PC PRE OTS", "code_information": [ { "code": "L0172", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 145.0, "minimum": 141.7759, "maximum": 246.7292, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 145.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 145.89, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 177.21, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 145.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 141.78, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 145.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 145.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 145.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 159.02, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 145.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 145.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 145.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 145.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 145.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 246.73, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CT ANGIO,HEAD COMBO,INCL IMAGE PROCESS", "code_information": [ { "code": "70496", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1910.0, "discounted_cash": 173.0, "minimum": 173.07, "maximum": 1766.7286, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 968.69, "10th_percentile": 968.69, "90th_percentile": 968.69, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 681.83, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 828.26, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 662.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1165.41, "10th_percentile": 1120.62, "90th_percentile": 1165.41, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1766.73 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 726.24, "10th_percentile": 543.27, "90th_percentile": 726.24, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 1332.42, "10th_percentile": 585.68, "90th_percentile": 1332.42, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 292.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC TRACHEOTOMY PLANNED", "code_information": [ { "code": "31600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9559.06, "discounted_cash": 3271.0, "minimum": 2867.718, "maximum": 9559.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9559.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9559.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9559.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3565.79, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5532.54, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITHOUT CCMCC", "code_information": [ { "code": "735", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11281.0, "minimum": 8401.8, "maximum": 29098.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10867.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 24312.97 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10867.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10867.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 29098.56 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 11281.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8401.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11281.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 29098.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10867.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 11281.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10867.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14964.22 } ] } ] }, { "description": "HC RP LOCLZJ TUM SPECT W/CT 1 AREA 1 DAY IMAGING", "code_information": [ { "code": "78830", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7706.56, "discounted_cash": 1277.0, "minimum": 1277.43, "maximum": 6720.1203, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 808.95, "10th_percentile": 808.95, "90th_percentile": 2843.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5032.56, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6113.4, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4890.9, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3238.05 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1392.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1277.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2160.39, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REMOVAL OF LEG ARTERY CLOT", "code_information": [ { "code": "34203", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13275.6, "discounted_cash": 5490.0, "minimum": 3982.68, "maximum": 13275.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13275.6, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 13275.6, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13275.6, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5984.62, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9285.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC", "code_information": [ { "code": "477", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 27321.0, "minimum": 23802.45, "maximum": 83714.8144, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 26258.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 62424.07 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 26258.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 26258.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 51023.3 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 27321.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23802.45 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 27321.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 51023.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 26258.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 27321.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 26258.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 38420.96 } ] } ] }, { "description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC", "code_information": [ { "code": "478", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19751.0, "minimum": 16186.22, "maximum": 54457.6128, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18994.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 44437.35 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 18994.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 18994.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 41906.98 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 19751.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16186.22 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19751.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 41907.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18994.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 19751.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18994.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27350.44 } ] } ] }, { "description": "HC HEP A ANTIBODY TOTAL", "code_information": [ { "code": "86708", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 185.63, "discounted_cash": 12.0, "minimum": 12.0406, "maximum": 161.8694, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 55.38, "10th_percentile": 55.38, "90th_percentile": 55.38, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.04, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 89.18, "10th_percentile": 89.18, "90th_percentile": 89.18, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 99.9, "10th_percentile": 95.98, "90th_percentile": 99.9, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 65.01 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.51, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 123.2, "10th_percentile": 64.8, "90th_percentile": 129.49, "count": "12" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.95, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Penicillin G Potassium For Inj 20000000 Unit", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00049053028", "type": "NDC" }, { "code": "J2540", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.677, "maximum": 1.677, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.68 } ] } ] }, { "description": "Fondaparinux Sodium Subcutaneous Inj 5 MG/0.4ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "55111067910", "type": "NDC" }, { "code": "J1652", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.849, "maximum": 1.849, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.85 } ] } ] }, { "description": "HC UGT1A1 GENE ANALYSIS COMMON VARIANTS", "code_information": [ { "code": "81350", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 825.63, "discounted_cash": 234.0, "minimum": 227.4012, "maximum": 825.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 234.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 234.0, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 284.24, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 234.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 227.4, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 825.63 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 234.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 234.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 234.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 255.06, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 234.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 234.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 234.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 234.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 234.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 395.74, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ERCP DESTRUCTION/LITHOTRIPSY CALCULI ANY METHOD", "code_information": [ { "code": "43265", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7151.56, "discounted_cash": 5990.0, "minimum": 2145.468, "maximum": 7151.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5990.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7151.56, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7151.56, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5990.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7151.56, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5990.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5990.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5990.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6529.27, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5990.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5990.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5990.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5990.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5990.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7151.56, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL C1766) INTRO/SHEATH,STRBLE,NON-PEEL", "code_information": [ { "code": "C1766", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 2485.9, "10th_percentile": 2485.9, "90th_percentile": 2485.9, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 3062.76, "10th_percentile": 3062.76, "90th_percentile": 3062.76, "count": "1 through 10" } ] } ] }, { "description": "HC REFILLING & MAINTENANCE PORTABLE PUMP", "code_information": [ { "code": "96521", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 271.56, "discounted_cash": 209.0, "minimum": 81.468, "maximum": 271.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 271.56, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 271.56, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 271.56, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 228.76, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 271.56, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PINWORM EXAM", "code_information": [ { "code": "87172", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 86.88, "discounted_cash": 4.0, "minimum": 4.1496, "maximum": 75.7594, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.19, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.15, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Bivalirudin Trifluoroacetate For IV Soln 250 MG (Base Equiv)", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "83634040041", "type": "NDC" }, { "code": "J0583", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC CT SCAN ABDOMEN/PELVIS W CONTRAST", "code_information": [ { "code": "74177", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3459.06, "discounted_cash": 344.0, "minimum": 344.22, "maximum": 3016.3003, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1592.47, "10th_percentile": 1592.47, "90th_percentile": 1592.47, "count": "20" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1356.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1647.33, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1317.92, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1842.24, "10th_percentile": 1842.24, "90th_percentile": 1915.9, "count": "42" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1986.13 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 871.83, "10th_percentile": 871.83, "90th_percentile": 1592.47, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 2190.46, "10th_percentile": 2190.46, "90th_percentile": 2190.46, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REVSC EVASC IVT ST CPLX 1ST", "code_information": [ { "code": "37260", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 55875.3, "discounted_cash": 11390.0, "minimum": 11390.68, "maximum": 54512.3773, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 44874.72, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 54512.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 43611.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12415.84, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19263.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH MCC", "code_information": [ { "code": "673", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33002.0, "minimum": 28997.6, "maximum": 92361.6302, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 31710.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 75922.24 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 31710.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 31710.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 77748.78 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 33002.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28997.6 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33002.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 77748.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 31710.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 33002.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 31710.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 46728.85 } ] } ] }, { "description": "PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR", "code_information": [ { "code": "041", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17770.0, "minimum": 15629.75, "maximum": 53311.9327, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 39730.16 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 17093.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 17093.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 46495.35 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 17770.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15629.75 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17770.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 46495.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17093.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 17770.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17093.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24453.24 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17093.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC CHEMOTX ADMN PRTL CAVITY PORT/CATH", "code_information": [ { "code": "96446", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 888.44, "discounted_cash": 325.0, "minimum": 266.532, "maximum": 888.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 888.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 888.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 888.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 355.24, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 551.18, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC URINE PREGNANCY TEST", "code_information": [ { "code": "81025", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 95.94, "discounted_cash": 8.0, "minimum": 8.3672, "maximum": 83.6597, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 51.58, "10th_percentile": 51.58, "90th_percentile": 61.4, "count": "27" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.46, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8.37, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 51.63, "10th_percentile": 51.63, "90th_percentile": 52.62, "count": "50" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 45.18 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 38.49, "10th_percentile": 38.49, "90th_percentile": 61.4, "count": "16" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 45.18, "10th_percentile": 45.18, "90th_percentile": 45.18, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.56, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MAJOR BLADDER PROCEDURES WITH CC", "code_information": [ { "code": "654", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22337.0, "minimum": 19532.69, "maximum": 79134.4534, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 21476.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 50582.9 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 21476.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 21476.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 54818.68 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 22337.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19532.69 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22337.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 54818.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 21476.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 22337.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 21476.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 31132.92 } ] } ] }, { "description": "PERITONEAL ADHESIOLYSIS WITH MCC", "code_information": [ { "code": "335", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 28206.0, "minimum": 25078.75, "maximum": 88035.8246, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 27107.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 64525.59 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 27107.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 27107.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 53117.78 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 28206.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25078.75 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 28206.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 53117.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 27107.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 28206.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 27107.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 39714.41 } ] } ] }, { "description": "HC ASSAY, THREE CATECHOLAMINES", "code_information": [ { "code": "82384", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 313.44, "discounted_cash": 25.0, "minimum": 24.5379, "maximum": 273.3197, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 30.67, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 24.54, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 132.49 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 112.87, "10th_percentile": 112.87, "90th_percentile": 112.87, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.52, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 42.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INJ NERV BLCK, TRIGEMINAL", "code_information": [ { "code": "64400", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1132.19, "discounted_cash": 302.0, "minimum": 302.87, "maximum": 1132.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1132.19, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1132.19, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1132.19, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 330.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 512.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L3935) FO NONTORSION JOINT CF", "code_information": [ { "code": "L3935", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 241.0, "minimum": 234.3496, "maximum": 407.8329, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 241.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 241.15, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 292.92, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 241.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 234.35, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 241.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 241.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 241.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 262.85, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 241.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 241.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 241.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 241.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 241.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 407.83, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC VENOUS CUTDOWN <1 Y/O", "code_information": [ { "code": "36420", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1008.75, "discounted_cash": 131.0, "minimum": 131.27, "maximum": 879.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 517.15, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 628.22, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 502.59, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.08, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 222.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ANTINUCLEAR ANTIBODIES TITER", "code_information": [ { "code": "86039", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 46.25, "discounted_cash": 11.0, "minimum": 10.8453, "maximum": 46.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 23.52, "10th_percentile": 23.52, "90th_percentile": 28.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.56, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 10.85, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 23.57, "10th_percentile": 22.3, "90th_percentile": 23.57, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 24.0, "10th_percentile": 24.0, "90th_percentile": 24.89, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 46.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 35.0, "10th_percentile": 35.0, "90th_percentile": 35.0, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.16, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 32.26, "10th_percentile": 30.8, "90th_percentile": 58.56, "count": "19" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.87, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PHENOTYPE INFECT AGENT DRUG", "code_information": [ { "code": "87900", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1351.56, "discounted_cash": 130.0, "minimum": 126.6741, "maximum": 1178.5603, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 130.35, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 158.34, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 126.67, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 683.97 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 130.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 130.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 142.08, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 130.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 130.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 220.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CYTOPATH FLUIDS,SMEAR,INTERP", "code_information": [ { "code": "88104", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 114.38, "discounted_cash": 36.0, "minimum": 34.314, "maximum": 114.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 114.38, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 114.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 114.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 114.38 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.32, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REPAIR LIP,FULL THICK,VERMILION", "code_information": [ { "code": "40650", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2236.88, "discounted_cash": 532.0, "minimum": 532.15, "maximum": 2236.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2096.46, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2236.88, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2037.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 580.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 532.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 899.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT INTER/SUBTROCH FX W MANIP", "code_information": [ { "code": "27240", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6001.88, "discounted_cash": 1586.0, "minimum": 1586.61, "maximum": 6001.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6001.88, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 6001.88, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6001.88, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1729.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2683.27, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INJ NERV BLCK, INTERCOSTAL, MULT, REGIONL", "code_information": [ { "code": "64421", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 102.5, "discounted_cash": 872.0, "minimum": 30.75, "maximum": 102.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 102.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 102.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 102.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 102.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 102.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 102.5, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 102.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 102.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 102.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CANNABINOIDS NATURAL ASSAY - G0480 - 30100418", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 429.69, "discounted_cash": 114.0, "minimum": 34.218, "maximum": 1015.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 254.02, "10th_percentile": 72.91, "90th_percentile": 807.41, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 139.0, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 111.2, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 156.38, "10th_percentile": 156.38, "90th_percentile": 171.03, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 823.75, "10th_percentile": 177.26, "90th_percentile": 856.52, "count": "28" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 429.69 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 206.85, "10th_percentile": 206.85, "90th_percentile": 470.25, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 124.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 229.77, "10th_percentile": 218.68, "90th_percentile": 917.78, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 193.52, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4336) URETHRAL INSERT", "code_information": [ { "code": "A4336", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 2.0, "minimum": 1.9922, "maximum": 3.467, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2.05, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2.49, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.99, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.23, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3.47, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL Q4114) INTEGRA FLOWABLE WOUND MATRIX", "code_information": [ { "code": "Q4114", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 3212.8525, "maximum": 3212.8525, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3212.85 } ] } ] }, { "description": "OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "425", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12458.0, "minimum": 10698.99, "maximum": 64808.6009, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11996.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 27110.18 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11996.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11996.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 32445.81 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12458.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10698.99 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12458.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32445.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11996.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 12458.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11996.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16685.86 } ] } ] }, { "description": "HC CLSD TREAT DIST FINGR FX WO MANIP EA", "code_information": [ { "code": "26750", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 438.44, "discounted_cash": 243.0, "minimum": 131.532, "maximum": 438.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 438.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 438.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 438.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 411.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC SPECIAL STAINS,GROUP I", "code_information": [ { "code": "88312", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 444.69, "discounted_cash": 51.0, "minimum": 51.42, "maximum": 444.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 160.0, "10th_percentile": 160.0, "90th_percentile": 320.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 202.57, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 246.08, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 196.87, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 107.63, "10th_percentile": 107.63, "90th_percentile": 438.78, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 444.69 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 107.52, "10th_percentile": 107.52, "90th_percentile": 160.0, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.05, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 279.04, "10th_percentile": 140.8, "90th_percentile": 281.6, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MRI BREAST W/OUT&WITH CONTRAST W/CAD UNILATERAL", "code_information": [ { "code": "77048", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1173.75, "minimum": 352.125, "maximum": 1173.75, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1173.75 } ] } ] }, { "description": "HC COMPATIBILITY TEST, ELECTRONIC", "code_information": [ { "code": "86923", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 96.25, "discounted_cash": 168.0, "minimum": 28.875, "maximum": 96.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 96.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 96.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 96.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 96.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 96.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 96.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 96.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 96.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 96.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 96.25, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 51.74, "10th_percentile": 51.74, "90th_percentile": 51.74, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.25, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "RENAL FAILURE WITHOUT CCMCC", "code_information": [ { "code": "684", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5613.0, "minimum": 4204.02, "maximum": 18589.9217, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5428.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 10847.33 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 5428.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 16310.95, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 5238.73, "10th_percentile": 5238.73, "90th_percentile": 5238.73, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 5428.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 8551.29 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 5613.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4204.02 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5613.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8551.29 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5428.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 5613.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 5428.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6676.34 } ] } ] }, { "description": "HC X-RAY ELBOW 3+ VW", "code_information": [ { "code": "73080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 533.44, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 465.1597, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 95.79, "10th_percentile": 95.79, "90th_percentile": 95.97, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 410.95, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 216.42 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 354.2, "10th_percentile": 327.15, "90th_percentile": 708.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Chlorpromazine HCl Tab 50 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "50268016411", "type": "NDC" }, { "code": "Q0161", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "Droperidol Inj 2.5 MG/ML", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "00143951401", "type": "NDC" }, { "code": "J1790", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 18.4255, "maximum": 18.4255, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 15.13, "10th_percentile": 12.71, "90th_percentile": 25.89, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.43 } ] } ] }, { "description": "HC EDUCATION&TRAINING SELF-MGMT NONPHYS 2-4 PTS - G0109 - 42998961", "code_information": [ { "code": "G0109", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 94.69, "discounted_cash": 15.0, "minimum": 14.888, "maximum": 94.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.61, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.89, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 94.69 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.7, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.91, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITHOUT CCMCC", "code_information": [ { "code": "845", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7524.0, "minimum": 5791.77, "maximum": 21733.7193, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7262.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 15388.28 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7262.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7262.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 18417.72 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7524.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5791.77 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7524.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18417.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7262.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7524.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7262.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9471.22 } ] } ] }, { "description": "HC EXHALED AIR ANALYSIS", "code_information": [ { "code": "94690", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 825.0, "discounted_cash": 58.0, "minimum": 58.2, "maximum": 719.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 229.28, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 278.53, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 222.83, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.44, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 98.43, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "GASTROINTESTINAL OBSTRUCTION WITH CC", "code_information": [ { "code": "389", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7054.0, "minimum": 5548.14, "maximum": 18710.1349, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6811.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 14271.56 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6811.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6811.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 11840.1 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7054.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5548.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7054.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11840.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6811.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7054.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6811.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8783.9 } ] } ] }, { "description": "HC SEMEN ANALYSIS, SPERM PRESENCE AND MOTILITY", "code_information": [ { "code": "89321", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 98.44, "discounted_cash": 12.0, "minimum": 11.7102, "maximum": 85.8397, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 49.9, "10th_percentile": 49.9, "90th_percentile": 49.9, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.64, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.71, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 50.16, "10th_percentile": 50.16, "90th_percentile": 50.16, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 63.23 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 49.9, "10th_percentile": 49.9, "90th_percentile": 49.9, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 63.23, "10th_percentile": 63.23, "90th_percentile": 68.67, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.38, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REPR WND INTRMD BODY/SCALP/EXTR 7.6-12.5 CM", "code_information": [ { "code": "12034", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 698.44, "discounted_cash": 401.0, "minimum": 209.532, "maximum": 698.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 698.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 437.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 678.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OSTEOMYELITIS WITH CC", "code_information": [ { "code": "540", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10906.0, "minimum": 8956.89, "maximum": 23423.9336, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10508.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 23423.93 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10508.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10508.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 15337.38 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 10906.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8956.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10906.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15337.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10508.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 10906.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10508.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14417.03 } ] } ] }, { "description": "OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC", "code_information": [ { "code": "699", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8767.0, "minimum": 7059.06, "maximum": 23639.5761, "payers_information": [ { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8455.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11288.51 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8455.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 18340.89 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8455.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8455.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 19078.21 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "other", "standard_charge_dollar": 23585.36, "standard_charge_algorithm": "87% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 13712.97, "10th_percentile": 13712.97, "90th_percentile": 13712.97, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8767.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7059.06 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8767.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19078.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8455.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8767.49, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC INSERT PM PULSE GEN ONLY (EXISTING LEADS)", "code_information": [ { "code": "33221", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 35935.9, "discounted_cash": 19005.0, "minimum": 10780.77, "maximum": 35935.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 35935.9, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 35935.9, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 35935.9, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20716.05, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19005.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32142.19, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MRA CHEST W CONTRAST, EXCLUDE HEART - C8909 - 61800004", "code_information": [ { "code": "C8909", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3750.94, "discounted_cash": 344.0, "minimum": 344.22, "maximum": 3270.8197, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1356.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1647.33, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1317.92, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Ropivacaine HCl Inj 5 MG/ML", "drug_information": { "unit": 20.0, "type": "ML" }, "code_information": [ { "code": "63323028605", "type": "NDC" }, { "code": "J2795", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 35.84, "10th_percentile": 11.99, "90th_percentile": 35.84, "count": "13" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 35.84, "10th_percentile": 35.84, "90th_percentile": 37.78, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL A5056) 1 PC OST POUCH W FILTER", "code_information": [ { "code": "A5056", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 6.0, "minimum": 6.4722, "maximum": 11.2634, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.66, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 6.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.26, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 6.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.26, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ANOSCOPY W REMOVE FOREIGN BODY", "code_information": [ { "code": "46608", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4313.44, "discounted_cash": 917.0, "minimum": 917.59, "maximum": 4313.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3614.94, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4313.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3513.18, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1000.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 917.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1551.83, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC M.PNEUMON DNA AMP PROBE", "code_information": [ { "code": "87581", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 76.25, "discounted_cash": 35.0, "minimum": 22.875, "maximum": 76.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 46.0, "10th_percentile": 38.64, "90th_percentile": 46.0, "count": "25" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 42.62, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 34.1, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 38.86, "10th_percentile": 38.86, "90th_percentile": 38.86, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 41.03, "10th_percentile": 39.42, "90th_percentile": 41.03, "count": "22" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 76.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 57.5, "10th_percentile": 46.0, "90th_percentile": 61.0, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 57.5, "10th_percentile": 57.5, "90th_percentile": 57.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 59.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "ADENOSINE 100 MCG/ML IN NS SYRINGE - CATH LAB (SITE)", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "09999401370", "type": "NDC" }, { "code": "J0153", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC OP CARDIAC REHAB WO CONT ECG MONIT PER SESSION", "code_information": [ { "code": "93797", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 135.63, "discounted_cash": 127.0, "minimum": 40.689, "maximum": 135.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 135.63, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 135.63, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 135.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 127.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 127.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.63, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 127.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 127.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 135.63, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L0120) CERV FLEX N/ADJ FOAM PRE OTS", "code_information": [ { "code": "L0120", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 30.0, "minimum": 29.6399, "maximum": 51.5816, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 30.5, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 37.05, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 29.64, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 30.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 30.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 30.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 30.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 51.58, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CT SCAN HEAD COMBO", "code_information": [ { "code": "70470", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2818.13, "discounted_cash": 173.0, "minimum": 173.07, "maximum": 2457.4094, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 229.98, "10th_percentile": 229.98, "90th_percentile": 229.98, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 681.83, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 828.26, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 662.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1038.4 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 292.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC", "code_information": [ { "code": "217", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 51055.0, "minimum": 44697.26, "maximum": 155998.2014, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 49032.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 118814.62 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 49032.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 49032.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 154164.88 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 51055.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44697.26 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 51055.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 154165.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 49032.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 51055.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 49032.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 73128.38 } ] } ] }, { "description": "MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITHOUT CCMCC", "code_information": [ { "code": "724", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6034.0, "minimum": 4546.62, "maximum": 14180.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5833.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 11848.39 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 5833.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 5833.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 14180.06 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6034.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4546.62 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6034.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14180.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5833.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 6034.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 5833.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7292.49 } ] } ] }, { "description": "Cefazolin Sodium For Inj 2 GM", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "44567084001", "type": "NDC" }, { "code": "J0690", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.7845, "maximum": 1.7845, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.78 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 25.87, "10th_percentile": 11.99, "90th_percentile": 26.05, "count": "1 through 10" } ] } ] }, { "description": "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC", "code_information": [ { "code": "147", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10718.0, "minimum": 8615.67, "maximum": 27499.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10327.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 22975.8 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10327.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10327.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 27498.96 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 10718.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8615.67 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10718.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 27499.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10327.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 10718.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10327.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14141.22 } ] } ] }, { "description": "HIV WITH MAJOR RELATED CONDITION WITHOUT CCMCC", "code_information": [ { "code": "976", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7913.0, "minimum": 6942.09, "maximum": 19522.43, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7635.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 16311.64 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7635.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7635.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 19522.43 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7913.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6942.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7913.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19522.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7635.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7913.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7635.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10039.54 } ] } ] }, { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CCMCC", "code_information": [ { "code": "017", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 42362.0, "minimum": 40691.5, "maximum": 117483.35, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 40691.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 98160.79 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 40691.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 40691.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 117483.35 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 42362.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41776.46 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 42362.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 117483.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 40691.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 42362.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 40691.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 60416.3 } ] } ] }, { "description": "OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC", "code_information": [ { "code": "315", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8374.0, "minimum": 6660.4, "maximum": 23231.8131, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 20913.96, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 11637.51, "10th_percentile": 11637.51, "90th_percentile": 11637.51, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8077.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 17406.68 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8077.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8077.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 16272.59 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8374.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6660.4 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8374.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16272.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 23231.81, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 43221.85, "10th_percentile": 43221.85, "90th_percentile": 43221.85, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8077.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8374.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8077.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10713.51 } ] } ] }, { "description": "Morphine Sulfate IV Soln 1 MG/ML - 09999612701 - 25000001", "drug_information": { "unit": 30.0, "type": "ML" }, "code_information": [ { "code": "09999612701", "type": "NDC" }, { "code": "J2270", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 9.9545, "maximum": 9.9545, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 11.99, "10th_percentile": 11.99, "90th_percentile": 47.95, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.95 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 11.99, "10th_percentile": 11.99, "90th_percentile": 14.13, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 16.49, "10th_percentile": 16.49, "90th_percentile": 16.49, "count": "1 through 10" } ] } ] }, { "description": "HC ECHO TTHRC R-T 2D W/WO M-MODE RST&STRS CONT ECG", "code_information": [ { "code": "93351", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3015.94, "discounted_cash": 539.0, "minimum": 539.15, "maximum": 2629.8997, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1513.51, "10th_percentile": 1513.51, "90th_percentile": 1513.51, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 539.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2124.04, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2580.21, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 539.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2064.24, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1840.2, "10th_percentile": 1750.9, "90th_percentile": 1875.67, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 1849.61, "10th_percentile": 1726.57, "90th_percentile": 1849.61, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 539.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 539.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 1894.01, "10th_percentile": 1894.01, "90th_percentile": 1894.01, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 539.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 587.67, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 539.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 539.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 1849.61, "10th_percentile": 1726.57, "90th_percentile": 2123.22, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 539.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 539.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 539.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 911.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Prochlorperazine Maleate Tab 10 MG (Base Equivalent)", "drug_information": { "unit": 50.0, "type": "EA" }, "code_information": [ { "code": "00904738206", "type": "NDC" }, { "code": "Q0164", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC (SUP SHELL A6238) HYDROCOLLD DRG >16<=48 W/BDR", "code_information": [ { "code": "A6238", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 32.0, "minimum": 31.5835, "maximum": 54.964, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 32.5, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 39.48, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 31.58, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 32.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 32.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 32.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 32.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 54.96, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Albumin, Human Inj 5%", "drug_information": { "unit": 500.0, "type": "ML" }, "code_information": [ { "code": "68516521402", "type": "NDC" }, { "code": "P9045", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 53.0, "minimum": 51.5831, "maximum": 209.1021, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 209.1, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 64.48, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 51.58, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 53.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 53.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 57.85, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 53.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 53.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 89.76, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL Q4168) AMNIOBAND, 1 MG", "code_information": [ { "code": "Q4168", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 36.6575, "maximum": 36.6575, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.66 } ] } ] }, { "description": "HC IRON BINDING TEST", "code_information": [ { "code": "83550", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 134.06, "discounted_cash": 8.0, "minimum": 8.4935, "maximum": 116.9003, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 85.8, "10th_percentile": 72.07, "90th_percentile": 85.8, "count": "35" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.74, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.62, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8.49, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 68.32, "10th_percentile": 68.32, "90th_percentile": 82.67, "count": "14" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 73.53, "10th_percentile": 72.15, "90th_percentile": 73.53, "count": "69" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 45.86 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 39.07, "10th_percentile": 39.07, "90th_percentile": 85.8, "count": "14" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.53, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 93.52, "10th_percentile": 45.86, "90th_percentile": 94.38, "count": "113" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PROSTATE SPECIFIC ANTIGEN,FREE", "code_information": [ { "code": "84154", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 402.5, "discounted_cash": 18.0, "minimum": 17.8714, "maximum": 350.98, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 82.2, "10th_percentile": 82.2, "90th_percentile": 82.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.34, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 17.87, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 205.11, "10th_percentile": 205.11, "90th_percentile": 205.11, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 96.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 82.2, "10th_percentile": 82.2, "90th_percentile": 82.2, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 280.78, "10th_percentile": 280.78, "90th_percentile": 280.79, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.1, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Fosphenytoin Sodium Inj 100 MG/2ML (Phenytoin Equiv)", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "00641613701", "type": "NDC" }, { "code": "Q2009", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 1.0, "minimum": 1.332, "maximum": 5.9985, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.12, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.45, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MORPH INSITU HYBRIDIZE MANL PER SPCMN EA MULTPLX PROB STAIN", "code_information": [ { "code": "88377", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1868.13, "discounted_cash": 168.0, "minimum": 168.1, "maximum": 1868.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 662.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 804.48, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 643.6, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 726.52, "10th_percentile": 726.52, "90th_percentile": 726.52, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1868.13 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 183.23, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 284.29, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC IRRIGAT CORPUS CAVERN,PRIAPISM", "code_information": [ { "code": "54220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1350.94, "discounted_cash": 246.0, "minimum": 246.53, "maximum": 1179.8186, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 971.23, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1179.82, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 943.89, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 268.72, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 416.93, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PAPPA SERUM", "code_information": [ { "code": "84163", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 250.94, "discounted_cash": 15.0, "minimum": 14.6256, "maximum": 218.8197, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.28, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.63, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 78.97 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC US,PREGNANT UTERUS,F/U,TRANSABD APP", "code_information": [ { "code": "76816", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 695.0, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 614.271, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 270.26, "10th_percentile": 270.26, "90th_percentile": 270.26, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 614.27 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Medroxyprogesterone Acetate IM Susp 150 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00548540000", "type": "NDC" }, { "code": "J1050", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.2255, "maximum": 1.2255, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.23 } ] } ] }, { "description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC", "code_information": [ { "code": "564", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12787.0, "minimum": 10860.95, "maximum": 27892.605, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12312.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 27892.61 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12312.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12312.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 22805.39 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12787.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10860.95 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12787.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22805.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12312.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 12787.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12312.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17167.43 } ] } ] }, { "description": "HC DUPLEX UP EXTREM ART BILAT", "code_information": [ { "code": "93930", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1981.88, "discounted_cash": 235.0, "minimum": 235.42, "maximum": 1728.1994, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 927.46, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1126.65, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 901.35, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 256.61, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "PNEUMOTHORAX WITH MCC", "code_information": [ { "code": "199", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14464.0, "minimum": 12218.22, "maximum": 31877.0047, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13922.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 31877.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13922.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13922.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 21792.26 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14464.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12218.22 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14464.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21792.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13922.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 14464.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13922.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19619.76 } ] } ] }, { "description": "HC (SUP SHELL A4556) ELECTRODES, PAIR", "code_information": [ { "code": "A4556", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 14.0, "minimum": 14.2952, "maximum": 24.8776, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.87, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.3, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.03, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.88, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CT SCAN OF ABDOMEN COMBO", "code_information": [ { "code": "74170", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3903.13, "discounted_cash": 173.0, "minimum": 173.07, "maximum": 3403.5294, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 725.3, "10th_percentile": 725.3, "90th_percentile": 736.7, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 681.83, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 828.26, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 662.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1787.2 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 2359.21, "10th_percentile": 2225.63, "90th_percentile": 2683.58, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 292.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MICROALBUMIN, QUANTITATIVE", "code_information": [ { "code": "82043", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 158.75, "discounted_cash": 5.0, "minimum": 5.617, "maximum": 138.43, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 106.7, "10th_percentile": 106.7, "90th_percentile": 106.7, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.78, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 97.0, "10th_percentile": 81.48, "90th_percentile": 97.0, "count": "22" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.02, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.62, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 77.24, "10th_percentile": 77.24, "90th_percentile": 77.24, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 83.13, "10th_percentile": 81.56, "90th_percentile": 83.13, "count": "44" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.33 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 25.84, "10th_percentile": 25.84, "90th_percentile": 25.84, "count": "20" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.3, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC PERQ PLCMT BILE DUCT STENT,NEW ACCESS WO SEP CATH", "code_information": [ { "code": "47539", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19083.1, "discounted_cash": 5965.0, "minimum": 5724.93, "maximum": 19083.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 19083.1, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 19083.1, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 19083.1, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6502.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10088.24, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC I&D THIGH/KNEE ABSCESS,DEEP", "code_information": [ { "code": "27301", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10259.7, "discounted_cash": 2866.0, "minimum": 2866.09, "maximum": 10259.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10259.7, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10259.7, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 10259.7, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3124.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4847.13, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC B-12 BINDING CAPACITY", "code_information": [ { "code": "82608", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 216.25, "discounted_cash": 14.0, "minimum": 13.9162, "maximum": 188.57, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.39, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13.92, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 75.14 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.61, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L4350) ANKLE CONTROL ORTHO PRE OTS", "code_information": [ { "code": "L4350", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 119.0, "minimum": 115.9649, "maximum": 201.8109, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 119.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 119.33, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 144.95, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 119.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 115.96, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 119.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 119.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 119.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 130.07, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 119.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 119.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 119.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 119.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 119.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 201.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L1686) HO POST-OP HIP ABDUCTION", "code_information": [ { "code": "L1686", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 1155.0, "minimum": 1123.0704, "maximum": 1954.4522, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1155.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1155.66, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1403.78, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1155.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1123.07, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1155.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1155.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1155.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1259.67, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1155.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1155.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1155.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1155.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1155.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1954.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL C9361) NEUROMEND NERVE WRAP", "code_information": [ { "code": "C9361", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 381.109, "maximum": 381.109, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 381.11 } ] } ] }, { "description": "Ampicillin Sodium For Inj 250 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "65219001401", "type": "NDC" }, { "code": "J0290", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.29, "maximum": 1.29, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.29 } ] } ] }, { "description": "HC WITHDRAWAL OF ARTERIAL BLOOD", "code_information": [ { "code": "36600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 156.56, "discounted_cash": 131.0, "minimum": 46.968, "maximum": 156.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 156.56, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 156.56, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 156.56, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.08, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 156.56, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC 3D RENDERING W/INTERP & POSTPROCESS SUPERVISION (76376)", "code_information": [ { "code": "76376", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1009.06, "minimum": 137.5043, "maximum": 879.9003, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 542.47, "10th_percentile": 542.47, "90th_percentile": 542.47, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 137.5 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 254.77, "10th_percentile": 254.77, "90th_percentile": 254.77, "count": "1 through 10" } ] } ] }, { "description": "HC OFFICE/OUTPATIENT NEW MODERATE MDM 45-59 MINUTES - G0463 - 76100004", "code_information": [ { "code": "G0463", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 280.63, "discounted_cash": 131.0, "minimum": 41.25, "maximum": 356.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 280.63, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 280.63, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 280.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.18, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 222.16, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Ampicillin Sodium For Inj 500 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00781340778", "type": "NDC" }, { "code": "J0290", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.29, "maximum": 1.29, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.29 } ] } ] }, { "description": "LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CCMCC", "code_information": [ { "code": "497", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10237.0, "minimum": 9292.58, "maximum": 24338.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9865.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 21833.79 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9865.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9865.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 24338.75 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 10237.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9292.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10237.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24338.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9865.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 10237.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9865.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13438.33 } ] } ] }, { "description": "HC (SUP SHELL A6452) HIGH COMPRES BAND W>=3<5YD - A6452 - 27100027", "code_information": [ { "code": "A6452", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 8.0, "minimum": 8.1631, "maximum": 14.2061, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.2, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8.16, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.16, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF OXALATE", "code_information": [ { "code": "83945", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 211.56, "discounted_cash": 14.0, "minimum": 14.0425, "maximum": 184.4803, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.55, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.04, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 75.82 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.75, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.44, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INSERT VENTR PM W TRANSVENOUS ELECTRODE", "code_information": [ { "code": "33207", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 38988.8, "discounted_cash": 10313.0, "minimum": 10313.01, "maximum": 38988.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 38988.8, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 38988.8, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 38988.8, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11241.18, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17441.36, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "SPINAL DISORDERS AND INJURIES WITH CCMCC", "code_information": [ { "code": "052", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14823.0, "minimum": 11215.4354, "maximum": 56114.34, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14266.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 32729.9 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14266.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14266.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 56114.34 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14823.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13929.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14823.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 56114.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14266.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 14823.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14266.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20144.7 } ] } ] }, { "description": "HC (SUP SHELL C2625) STENT NON-COR TEMP W/DELIV SYSTEM", "code_information": [ { "code": "C2625", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 208.93, "10th_percentile": 208.93, "90th_percentile": 208.93, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 220.4, "10th_percentile": 220.4, "90th_percentile": 220.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 220.4, "10th_percentile": 206.02, "90th_percentile": 250.7, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL A4428) URINE OST POUCH W FAUCET/TAP", "code_information": [ { "code": "A4428", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 9.0, "minimum": 9.028, "maximum": 15.7112, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.29, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.28, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9.03, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 9.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 9.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 9.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.71, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC EXPOSE FEMORAL ART, GROIN INCIS UNI (AAA REPR)", "code_information": [ { "code": "34812", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1609.38, "minimum": 482.814, "maximum": 1609.38, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 1609.38 } ] } ] }, { "description": "PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC", "code_information": [ { "code": "242", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 25330.0, "minimum": 23477.15, "maximum": 88478.321, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24348.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 57693.39 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 24348.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24348.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 69115.65 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 25330.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23477.15 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 25330.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 69115.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24348.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 25330.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 24348.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 35509.3 } ] } ] }, { "description": "Metronidazole IV Soln 500 MG/100ML", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "00409015201", "type": "NDC" }, { "code": "J1836", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC HEMOGLOBIN ELECTROPHORESIS", "code_information": [ { "code": "83020", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 233.13, "discounted_cash": 12.0, "minimum": 12.5071, "maximum": 203.2894, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.63, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.51, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 67.53 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.03, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.77, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PROTEIN TOT XCPT REFRACTOMETRY SERUM", "code_information": [ { "code": "84155", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 94.38, "discounted_cash": 3.0, "minimum": 3.5665, "maximum": 82.2994, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 50.74, "10th_percentile": 48.38, "90th_percentile": 60.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.46, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3.57, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 48.09, "10th_percentile": 48.09, "90th_percentile": 48.09, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 48.43, "10th_percentile": 48.43, "90th_percentile": 51.76, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.26 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 16.4, "10th_percentile": 16.4, "90th_percentile": 60.4, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 66.44, "10th_percentile": 63.36, "90th_percentile": 66.44, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6216) NON-STERILE GAUZE<=16 SQ IN - A6216 - 27100086", "code_information": [ { "code": "A6216", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PERCUT BIOPSY, ABDOMINAL MASS", "code_information": [ { "code": "49180", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1909.06, "discounted_cash": 1629.0, "minimum": 572.718, "maximum": 1909.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1909.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1909.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1909.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 1168.3, "10th_percentile": 1168.3, "90th_percentile": 1168.3, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 1198.89, "10th_percentile": 1198.89, "90th_percentile": 1198.89, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1776.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1909.06, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC TRACHEOTOMY ER CRICOTHROID MEMBRANE", "code_information": [ { "code": "31605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3653.44, "discounted_cash": 233.0, "minimum": 233.7, "maximum": 3185.7997, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 920.68, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1118.42, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 894.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 254.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 395.23, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC UNLISTED DX RADIOGRAPHIC PROCEDURE", "code_information": [ { "code": "76499", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 188.75, "discounted_cash": 85.0, "minimum": 56.625, "maximum": 188.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 188.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 188.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 188.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A2002) MIRRAGEN ADV WND MAT PER SQ", "code_information": [ { "code": "A2002", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 126.52, "maximum": 605.4868, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Ampicillin & Sulbactam Sodium For Inj 3 (2-1) GM", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00049001481", "type": "NDC" }, { "code": "J0295", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 3.3755, "maximum": 3.3755, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.38 } ] } ] }, { "description": "HC CYTOPATH, CELL ENHANCE TECH", "code_information": [ { "code": "88112", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 169.38, "discounted_cash": 51.0, "minimum": 50.814, "maximum": 169.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 135.5, "10th_percentile": 135.5, "90th_percentile": 135.5, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 169.38, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 169.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 169.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 169.38 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.05, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 118.16, "10th_percentile": 118.16, "90th_percentile": 118.16, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT TOE FX W MANIP EA", "code_information": [ { "code": "28515", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 424.38, "discounted_cash": 243.0, "minimum": 127.314, "maximum": 424.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 424.38, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 424.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 424.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 411.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC TOBACCO CESSATION ASYMPTOMATIC 3-10 MIN", "code_information": [ { "code": "99406", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 64.69, "discounted_cash": 36.0, "minimum": 19.407, "maximum": 64.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 64.69, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 64.69, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 64.69, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 36.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 36.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.3, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 36.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.52, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INJ NERV BLCK, INTERCOSTAL, SINGLE", "code_information": [ { "code": "64420", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3512.81, "discounted_cash": 696.0, "minimum": 696.49, "maximum": 3333.1922, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2743.89, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3333.19, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2666.65, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 759.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1177.9, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC LYME DISEASE ANTIBODY, CONFIRMATORY", "code_information": [ { "code": "86617", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 139.38, "discounted_cash": 15.0, "minimum": 15.0532, "maximum": 121.5394, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 138.48, "10th_percentile": 138.48, "90th_percentile": 138.48, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.49, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.82, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 150.01, "10th_percentile": 144.32, "90th_percentile": 150.01, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 81.28 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 15.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 138.48, "10th_percentile": 138.48, "90th_percentile": 138.48, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 15.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 194.46, "10th_percentile": 162.56, "90th_percentile": 194.46, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 15.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.2, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC BYPASS W/VEIN FEMORAL-POPLITEAL", "code_information": [ { "code": "35556", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6385.0, "minimum": 1915.5, "maximum": 6385.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 6385.0 } ] } ] }, { "description": "HC ASSAY OF METHADONE - 80358 - 30100205", "code_information": [ { "code": "80358", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 194.38, "minimum": 58.314, "maximum": 169.4994, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 68.84 } ] } ] }, { "description": "HC BIOPSY FOREARM SOFT TISSUES,SUPERFIC", "code_information": [ { "code": "25065", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4690.31, "discounted_cash": 1629.0, "minimum": 1407.093, "maximum": 4690.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4690.31, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4690.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4690.31, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1776.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2756.05, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REPAIR SINGLE TRANSVEN ELECTROD/PM/DEFIB", "code_information": [ { "code": "33218", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7560.31, "discounted_cash": 3687.0, "minimum": 2268.093, "maximum": 7560.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7560.31, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7560.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7560.31, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4019.11, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3687.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6235.89, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Cangrelor Tetrasodium For IV Soln 50 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "10122062001", "type": "NDC" }, { "code": "C9460", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 20.0, "minimum": 19.4554, "maximum": 78.8787, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 78.88, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.32, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 19.46, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 43.92 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 20.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 20.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.82, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 20.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.86, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC TEAEC W/WO PATCH GRAFT COMMON FEMORAL", "code_information": [ { "code": "35371", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12131.3, "minimum": 2944.0066, "maximum": 10578.4936, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 2944.01 } ] } ] }, { "description": "HC PRQ ASPIR PULPOSUS/INTERVERTEBRAL DISC/PVRT TISS - 62267 - 36162267", "code_information": [ { "code": "62267", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1589.38, "discounted_cash": 698.0, "minimum": 476.814, "maximum": 1589.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1589.38, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1589.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1589.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 761.59, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1181.66, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DIGITAL BREAST TOMOSYNTHESIS BILAT - 77062 - 40100011", "code_information": [ { "code": "77062", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 796.88, "minimum": 239.064, "maximum": 796.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 510.0, "10th_percentile": 510.0, "90th_percentile": 510.0, "count": "12" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 404.18, "10th_percentile": 404.18, "90th_percentile": 404.18, "count": "13" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 495.59, "10th_percentile": 486.22, "90th_percentile": 495.59, "count": "25" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 796.88 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 500.44, "10th_percentile": 500.44, "90th_percentile": 510.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 555.9, "10th_percentile": 488.71, "90th_percentile": 561.0, "count": "19" } ] } ] }, { "description": "HC INJ DX/THER SBST INTRLMNR LMBR/SAC WO IMG", "code_information": [ { "code": "62322", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3057.81, "discounted_cash": 872.0, "minimum": 872.7, "maximum": 3057.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3057.81, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3057.81, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3057.81, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 951.24, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 872.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1475.91, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6441) PAD BAND W>=3 <5/YD", "code_information": [ { "code": "A6441", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.6405, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.18, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.06, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1.64, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6204) COMPOSITE DRSG >16<=48 SQ IN - A6204 - RU272042", "code_information": [ { "code": "A6204", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 8.0, "minimum": 8.6101, "maximum": 14.984, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.86, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.76, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.98, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF VITAMIN A", "code_information": [ { "code": "84590", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 199.06, "discounted_cash": 11.0, "minimum": 11.2826, "maximum": 173.5803, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 107.02, "10th_percentile": 107.02, "90th_percentile": 107.02, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.1, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.28, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 101.44, "10th_percentile": 101.44, "90th_percentile": 101.44, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 109.18, "10th_percentile": 107.13, "90th_percentile": 109.18, "count": "11" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 60.92 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 51.9, "10th_percentile": 51.9, "90th_percentile": 127.4, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 138.87, "10th_percentile": 138.87, "90th_percentile": 140.14, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Ceftolozane-Tazobactam For Inj 1.5 GM (1-0.5 GM)", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "67919003001", "type": "NDC" }, { "code": "J0695", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 8.0, "minimum": 8.8142, "maximum": 34.8103, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 34.81, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.02, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8.81, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.29 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.63, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.94, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT TALUS FX W MANIP", "code_information": [ { "code": "28435", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2257.81, "discounted_cash": 1586.0, "minimum": 677.343, "maximum": 2257.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2257.81, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2257.81, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2257.81, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1729.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2257.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PERQ SKEL FIXJ DISTAL RADIAL FX/EPIPHYSL SEP", "code_information": [ { "code": "25606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11957.5, "discounted_cash": 3228.0, "minimum": 3228.48, "maximum": 11957.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11957.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 11957.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11957.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3519.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5460.01, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC THROMBOLYSIS ARTERIAL INFUSION W/IMG INIT TX", "code_information": [ { "code": "37211", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3611.56, "discounted_cash": 5490.0, "minimum": 1083.468, "maximum": 3611.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3611.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3611.56, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3611.56, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3611.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3611.56, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3611.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3611.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3611.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3611.56, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3611.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3611.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3611.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3611.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3611.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3611.56, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC HEPARIN NEUTRALIZATION", "code_information": [ { "code": "85525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 191.56, "discounted_cash": 11.0, "minimum": 11.5061, "maximum": 167.0403, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.38, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.51, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 62.13 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.02, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ANGIO ADRENAL UNILAT SELECT", "code_information": [ { "code": "75731", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1634.06, "discounted_cash": 3115.0, "minimum": 490.218, "maximum": 1634.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 877.52 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1634.06, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MRI, DORSAL SPINE", "code_information": [ { "code": "72146", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2612.81, "discounted_cash": 235.0, "minimum": 235.42, "maximum": 2278.3703, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 245.16, "10th_percentile": 245.16, "90th_percentile": 490.31, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 927.46, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1126.65, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 901.35, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1594.23, "10th_percentile": 1594.23, "90th_percentile": 1594.23, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1108.61 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 256.61, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 1822.7, "10th_percentile": 1822.7, "90th_percentile": 1822.7, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MASSAGE THERAPY EA 15 MIN", "code_information": [ { "code": "97124", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 202.5, "discounted_cash": 28.0, "minimum": 27.3853, "maximum": 176.58, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 28.18, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 34.23, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 27.39, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 28.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 28.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.72, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 28.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 28.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 47.66, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC COCCIDIOIDES, ANTIBODY", "code_information": [ { "code": "86635", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 81.56, "discounted_cash": 11.0, "minimum": 11.1465, "maximum": 71.1203, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.93, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 60.19 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.5, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "KCl 40 MEQ/L (0.3%) in Dextrose 5% & NaCl 0.45% Inj", "drug_information": { "unit": 1000.0, "type": "ML" }, "code_information": [ { "code": "00338067504", "type": "NDC" }, { "code": "J3480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 58.52, "10th_percentile": 58.52, "90th_percentile": 58.52, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC (SUP SHELL C2617) STENT NON-COR TEMP W/O DELIV SYSTEM", "code_information": [ { "code": "C2617", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 180.6, "10th_percentile": 180.6, "90th_percentile": 365.57, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 219.28, "10th_percentile": 208.93, "90th_percentile": 634.76, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 422.4, "10th_percentile": 220.4, "90th_percentile": 913.79, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 220.4, "10th_percentile": 220.4, "90th_percentile": 220.4, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL L1830) KO IMMOB CANVAS LONG PRE OTS", "code_information": [ { "code": "L1830", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 74.0, "minimum": 72.6809, "maximum": 126.4848, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 74.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 74.79, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 90.85, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 74.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 72.68, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 74.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 74.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 74.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 81.52, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 74.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 74.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 74.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 74.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 74.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 126.48, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CCMCC", "code_information": [ { "code": "658", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12850.0, "minimum": 10409.68, "maximum": 38867.0705, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12372.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 28040.78 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12372.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 34102.29, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 36427.46, "10th_percentile": 36427.46, "90th_percentile": 36427.46, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12372.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 36305.49 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12850.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10409.68 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12850.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 36305.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12372.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 12850.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12372.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17258.62 } ] } ] }, { "description": "Antithrombin III (Human) For Inj 500 Unit", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "13533060612", "type": "NDC" }, { "code": "J7197", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 4.0, "minimum": 3.9844, "maximum": 16.1524, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.15, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.98, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3.98, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.47 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 4.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.47, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.93, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC HPV HIGH-RISK TYPES", "code_information": [ { "code": "87624", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 220.31, "discounted_cash": 35.0, "minimum": 34.1005, "maximum": 192.1103, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 133.0, "10th_percentile": 111.72, "90th_percentile": 133.0, "count": "17" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 42.62, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 34.1, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 105.9, "10th_percentile": 105.9, "90th_percentile": 112.27, "count": "35" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 113.98, "10th_percentile": 113.98, "90th_percentile": 118.56, "count": "66" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 184.12 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 156.85, "10th_percentile": 156.85, "90th_percentile": 156.85, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 146.3, "10th_percentile": 146.3, "90th_percentile": 146.3, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 59.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "SKIN ULCERS WITH MCC", "code_information": [ { "code": "592", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15766.0, "minimum": 14232.33, "maximum": 41854.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15171.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 34970.56 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 15171.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 15171.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 41854.38 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 15766.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14232.33 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15766.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 41854.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15171.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 15766.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15171.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21523.79 } ] } ] }, { "description": "MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC", "code_information": [ { "code": "371", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14533.0, "minimum": 12098.48, "maximum": 41500.1813, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13987.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 32039.63 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13987.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13987.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 26943.68 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14533.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12098.48 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14533.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26943.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13987.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 14533.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13987.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19719.85 } ] } ] }, { "description": "HC NM BOWEL IMAGING", "code_information": [ { "code": "78290", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1090.63, "discounted_cash": 394.0, "minimum": 327.189, "maximum": 1090.63, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1090.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1090.63 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1090.63, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1090.63, "additional_payer_notes": "478.57% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L8600) IMPLANT BREAST SILICONE/EQ", "code_information": [ { "code": "L8600", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 771.0, "minimum": 749.3939, "maximum": 1304.152, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 771.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 771.14, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 936.7, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 771.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 749.39, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 771.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 771.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 771.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 840.54, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 771.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 771.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 771.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 771.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 771.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1304.15, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC RENAL FUNCTION PANEL", "code_information": [ { "code": "80069", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 217.19, "discounted_cash": 8.0, "minimum": 8.4352, "maximum": 189.3897, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 131.2, "10th_percentile": 131.2, "90th_percentile": 131.2, "count": "21" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.68, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.54, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 110.68, "10th_percentile": 104.47, "90th_percentile": 110.68, "count": "11" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 116.88, "10th_percentile": 112.44, "90th_percentile": 116.88, "count": "18" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 45.55 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 38.8, "10th_percentile": 38.8, "90th_percentile": 38.8, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.46, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 144.32, "10th_percentile": 144.32, "90th_percentile": 144.32, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.68, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REMOVE FOREIGN BODY COMPLEX", "code_information": [ { "code": "10121", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1211.56, "discounted_cash": 1629.0, "minimum": 363.468, "maximum": 1211.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1211.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1211.56, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1211.56, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1211.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1211.56, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1211.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1211.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1211.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1211.56, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1211.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1211.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1211.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1211.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1211.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1211.56, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4424) OST PCH DRAIN W BAR & FILTER - A4424 - RU272037", "code_information": [ { "code": "A4424", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 6.0, "minimum": 6.5888, "maximum": 11.4663, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.78, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.24, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6.59, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 6.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.39, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 6.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MICROSLIDE CONSULT", "code_information": [ { "code": "88321", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1369.06, "discounted_cash": 36.0, "minimum": 36.85, "maximum": 1193.8203, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 145.17, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 176.35, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 141.09, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 626.15 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.32, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY LUMBAR SPINE 2/3 VW", "code_information": [ { "code": "72100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 705.63, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 615.3094, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 426.0, "10th_percentile": 426.0, "90th_percentile": 426.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 357.89, "10th_percentile": 337.61, "90th_percentile": 715.78, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 430.54, "10th_percentile": 413.97, "90th_percentile": 430.54, "count": "16" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 257.44 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 114.48, "10th_percentile": 114.48, "90th_percentile": 119.17, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 468.6, "10th_percentile": 207.32, "90th_percentile": 492.24, "count": "23" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT A-C JT DISLOC WO MANIP", "code_information": [ { "code": "23540", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 300.94, "discounted_cash": 243.0, "minimum": 90.282, "maximum": 300.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 300.94, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 300.94, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 300.94, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 300.94, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC EX FOR SPEECH DEVICE RX EA ADD 30 MIN", "code_information": [ { "code": "92608", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 480.94, "discounted_cash": 45.0, "minimum": 44.5182, "maximum": 419.3797, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 45.81, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 55.65, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 44.52, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 45.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 45.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.93, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 45.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 45.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 77.47, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4616) TUBING (OXYGEN) PER FOOT", "code_information": [ { "code": "A4616", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC", "code_information": [ { "code": "283", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16112.0, "minimum": 13533.97, "maximum": 54602.41, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15503.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 35792.74 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 15503.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 15503.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 54602.41 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 16112.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13533.97 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16112.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 54602.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15503.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 16112.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15503.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22029.82 } ] } ] }, { "description": "HC PENILE VASCULAR STUDY,LTD OR F/U", "code_information": [ { "code": "93981", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1222.5, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 1066.02, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC VENOUS CUTDOWN >1 Y/O", "code_information": [ { "code": "36425", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1008.75, "discounted_cash": 440.0, "minimum": 302.625, "maximum": 1008.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1008.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1008.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1008.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 480.45, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 440.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 745.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4409) OST SKN BARR CONVEX <=4 SQ I", "code_information": [ { "code": "A4409", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 8.0, "minimum": 8.5907, "maximum": 14.9502, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.84, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8.59, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.64, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.95, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6210) FOAM DRG >16<=48 SQ IN W/O B - A6210 - RU272043", "code_information": [ { "code": "A6210", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 28.0, "minimum": 27.5991, "maximum": 48.0301, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 28.4, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 34.5, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 27.6, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 28.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 28.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.96, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 28.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 28.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 48.03, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC HEART INFARCT IMAGE", "code_information": [ { "code": "78466", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 792.5, "discounted_cash": 394.0, "minimum": 237.75, "maximum": 792.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 792.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 792.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 792.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 792.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF AMITRIPTYLINE - G0480 - 30100408", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 221.25, "discounted_cash": 114.0, "minimum": 34.218, "maximum": 1015.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 254.02, "10th_percentile": 72.91, "90th_percentile": 807.41, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 139.0, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 111.2, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 156.38, "10th_percentile": 156.38, "90th_percentile": 171.03, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 823.75, "10th_percentile": 177.26, "90th_percentile": 856.52, "count": "28" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 221.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 206.85, "10th_percentile": 206.85, "90th_percentile": 470.25, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 124.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 229.77, "10th_percentile": 218.68, "90th_percentile": 917.78, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 193.52, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC EX FOR NONSPEECH DEVICE RX INIT HR", "code_information": [ { "code": "92605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 638.13, "minimum": 95.0, "maximum": 556.4494, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "HC CT ANGIO,NECK COMBO,INCL IMAGE PROCESS", "code_information": [ { "code": "70498", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1901.25, "discounted_cash": 173.0, "minimum": 173.07, "maximum": 1763.8241, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 964.32, "10th_percentile": 964.32, "90th_percentile": 964.32, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 681.83, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 828.26, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 662.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1160.07, "10th_percentile": 1115.57, "90th_percentile": 1160.07, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1763.82 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 726.24, "10th_percentile": 726.24, "90th_percentile": 726.24, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 1326.31, "10th_percentile": 583.0, "90th_percentile": 1326.31, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 292.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC", "code_information": [ { "code": "917", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12976.0, "minimum": 11348.9, "maximum": 32337.066, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 29110.78, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 29187.42, "10th_percentile": 29187.42, "90th_percentile": 29187.42, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12493.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 28340.74 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12493.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12493.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 25597.38 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12976.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11348.9 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12976.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25597.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12493.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 12976.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12493.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17443.24 } ] } ] }, { "description": "HC I&D ARM/ELBOW INFECT BURSA", "code_information": [ { "code": "23931", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1144.06, "discounted_cash": 1629.0, "minimum": 343.218, "maximum": 1144.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1144.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1144.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1144.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1144.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1144.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1144.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1144.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1144.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1144.06, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1144.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1144.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1144.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1144.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1144.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1144.06, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC THYROID MET IMAGING LTD", "code_information": [ { "code": "78015", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1523.44, "discounted_cash": 394.0, "minimum": 394.45, "maximum": 1523.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1523.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1523.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1510.23, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1523.44 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "738", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12216.0, "minimum": 10498.97, "maximum": 34322.8583, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11764.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 26535.56 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11764.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11764.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 31672.33 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12216.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10498.97 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12216.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 31672.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11764.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 12216.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11764.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16332.19 } ] } ] }, { "description": "MAJOR HEAD AND NECK PROCEDURES WITH MCC", "code_information": [ { "code": "140", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33487.0, "minimum": 9595.6, "maximum": 77073.2886, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 32175.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 77073.29 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 32175.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 32175.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 9595.6 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 33487.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29271.69 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33487.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9595.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 32175.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 33487.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 32175.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 47437.3 } ] } ] }, { "description": "HC DIGITAL BREAST TOMOSYNTHESIS UNILAT - G0279 - 40100010", "code_information": [ { "code": "G0279", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 501.88, "discounted_cash": 11.0, "minimum": 11.3506, "maximum": 694.8794, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.68, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.19, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.35, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 84.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.75, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MAJOR ESOPHAGEAL DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "370", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6377.0, "minimum": 4831.09, "maximum": 13704.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6162.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 12663.34 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6162.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6162.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 13704.67 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6377.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4831.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6377.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13704.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6162.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 6377.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6162.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7794.07 } ] } ] }, { "description": "KIDNEY AND URINARY TRACT NEOPLASMS WITH CC", "code_information": [ { "code": "687", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9016.0, "minimum": 7286.08, "maximum": 21049.93, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8694.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 18933.58 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8694.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 17059.86, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 13534.42, "10th_percentile": 13534.42, "90th_percentile": 13534.42, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8694.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 21049.93 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9016.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7286.08 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9016.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21049.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8694.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 9016.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8694.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11653.3 } ] } ] }, { "description": "FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC", "code_information": [ { "code": "562", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11884.0, "minimum": 10129.37, "maximum": 25926.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11445.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 25745.91 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11445.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11445.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 25926.65 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 11884.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10129.37 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11884.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25926.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11445.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 11884.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11445.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15846.17 } ] } ] }, { "description": "HC CLSD TREAT POST HIP FIX DISLOC W ANES", "code_information": [ { "code": "27266", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7210.31, "discounted_cash": 1586.0, "minimum": 1586.61, "maximum": 7210.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6250.61, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7210.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6074.65, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1729.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2683.27, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L3980) UPP EXT FX ORTHOSIS HUMERAL", "code_information": [ { "code": "L3980", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 463.0, "minimum": 450.4293, "maximum": 783.8712, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 463.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 463.5, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 563.01, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 463.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 450.43, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 463.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 463.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 463.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 505.22, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 463.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 463.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 463.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 463.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 463.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 783.87, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC FACTOR INHIBITOR TEST", "code_information": [ { "code": "85335", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 601.25, "discounted_cash": 12.0, "minimum": 12.5071, "maximum": 524.29, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.63, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.51, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 67.53 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.03, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.77, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY JOINT SURVEY SINGLE VW", "code_information": [ { "code": "77077", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 390.63, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 390.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 390.63, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 390.63, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 390.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 269.13 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH CC", "code_information": [ { "code": "496", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14767.0, "minimum": 13655.78, "maximum": 109576.331, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14212.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 43904.05 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14767.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13655.78 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14767.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 43904.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14212.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 14767.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14212.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20062.4 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14212.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 32596.18 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14212.4, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Atropine Sulfate Inj 0.4 MG/ML", "drug_information": { "unit": 20.0, "type": "ML" }, "code_information": [ { "code": "00641625101", "type": "NDC" }, { "code": "J0461", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 19.41, "10th_percentile": 19.41, "90th_percentile": 19.41, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CCMCC", "code_information": [ { "code": "744", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16632.0, "minimum": 13524.28, "maximum": 39022.8574, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16001.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 37026.91 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 16001.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 16001.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 27820.44 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 16632.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13524.28 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16632.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 27820.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16001.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 16632.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16001.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22789.43 } ] } ] }, { "description": "HC BACTERIUM, ANTIBODY", "code_information": [ { "code": "86609", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 422.5, "discounted_cash": 12.0, "minimum": 12.5168, "maximum": 368.42, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.65, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.52, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 67.58 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.78, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "FRACTURES OF HIP AND PELVIS WITHOUT MCC", "code_information": [ { "code": "536", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7190.0, "minimum": 5612.51, "maximum": 19322.4457, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6941.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 14593.2 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6941.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6941.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 14569.73 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7190.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5612.51 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7190.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14569.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6941.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7190.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6941.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8981.87 } ] } ] }, { "description": "HC SUTR WND EYELID/MARGIN/TARSUS/CONJUNC PRTL THICK", "code_information": [ { "code": "67930", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9625.0, "discounted_cash": 2345.0, "minimum": 2345.87, "maximum": 9625.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2345.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9241.79, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9625.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2345.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8981.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2345.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2345.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2345.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2557.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2345.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2345.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2345.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2345.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2345.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3967.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6242) HYDROGEL DRG <=16 IN W/O BDR", "code_information": [ { "code": "A6242", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 8.0, "minimum": 8.3866, "maximum": 14.5951, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.63, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.48, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8.39, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.41, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ED LEVEL 2", "code_information": [ { "code": "99282", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 523.13, "discounted_cash": 151.0, "minimum": 151.49, "maximum": 523.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 244.61, "10th_percentile": 244.61, "90th_percentile": 291.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 151.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 523.13, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 523.13, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 151.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 523.13, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.3, "median_amount": 308.91, "10th_percentile": 279.92, "90th_percentile": 559.84, "count": "13" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 282.97, "10th_percentile": 282.97, "90th_percentile": 319.19, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 406.68, "10th_percentile": 320.82, "90th_percentile": 585.49, "count": "14" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 151.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 151.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 288.29, "10th_percentile": 288.29, "90th_percentile": 288.29, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 151.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 165.12, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 151.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 151.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 364.93, "10th_percentile": 364.93, "90th_percentile": 364.93, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 151.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 151.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 151.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 256.2, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "DIABETES WITH MCC", "code_information": [ { "code": "637", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11974.0, "minimum": 10079.53, "maximum": 43536.5603, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 39192.89, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 25600.1, "10th_percentile": 25600.1, "90th_percentile": 25600.1, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11532.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 25960.94 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11532.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 38199.34, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 33422.67, "10th_percentile": 33422.67, "90th_percentile": 33422.67, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11532.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 21548.71 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 11974.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10079.53 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11974.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21548.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11532.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 11974.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11532.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15978.52 } ] } ] }, { "description": "OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "356", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 34456.0, "minimum": 29524.32, "maximum": 80541.3116, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 33105.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 79377.19 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 33105.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 33105.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 64751.35 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 34456.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29524.32 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 34456.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 64751.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 33105.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 34456.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 33105.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 48855.32 } ] } ] }, { "description": "HC ASSAY BLOOD CARBON DIOXIDE", "code_information": [ { "code": "82374", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 47.19, "discounted_cash": 4.0, "minimum": 4.7424, "maximum": 41.1497, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 25.37, "10th_percentile": 25.37, "90th_percentile": 30.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.93, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 24.05, "10th_percentile": 24.05, "90th_percentile": 24.05, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 25.88, "10th_percentile": 25.88, "90th_percentile": 25.88, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.61 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 32.92, "10th_percentile": 32.92, "90th_percentile": 32.92, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.25, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "TENDONITIS, MYOSITIS AND BURSITIS WITH MCC", "code_information": [ { "code": "557", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12356.0, "minimum": 10725.99, "maximum": 34315.7346, "payers_information": [ { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11899.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16536.83 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11899.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 26868.05 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11899.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11899.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 21307.11 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12356.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10725.99 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12356.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21307.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11899.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 12356.5, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC SEMEN ANALYSIS,MOTIL & COUNT W/O HUHNER", "code_information": [ { "code": "89310", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 157.5, "discounted_cash": 8.0, "minimum": 8.3672, "maximum": 137.34, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.46, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8.37, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 45.18 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.56, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MALIGNANT BREAST DISORDERS WITH CC", "code_information": [ { "code": "598", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9652.0, "minimum": 7342.15, "maximum": 26117.1674, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9303.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 20442.41 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9303.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9303.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 17363.67 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9652.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7342.15 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9652.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17363.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9303.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 9652.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9303.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12581.96 } ] } ] }, { "description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC", "code_information": [ { "code": "432", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16016.0, "minimum": 13559.58, "maximum": 50357.4686, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15411.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 35565.06 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 15411.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 15411.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 42738.93 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 16016.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13559.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16016.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 42738.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 50357.47, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 15796.33, "10th_percentile": 15796.33, "90th_percentile": 35190.55, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15411.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 16016.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15411.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21889.69 } ] } ] }, { "description": "CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC", "code_information": [ { "code": "261", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15426.0, "minimum": 13133.92, "maximum": 39783.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14844.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 34161.03 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14844.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14844.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 39783.29 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 15426.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13133.92 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15426.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 39783.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14844.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 15426.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14844.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21025.54 } ] } ] }, { "description": "HC TRANSABDOMINAL AMNIOINFUSION W/ULTRSND GUIDANCE", "code_information": [ { "code": "59070", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 478.44, "discounted_cash": 300.0, "minimum": 143.532, "maximum": 478.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 478.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 478.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 478.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 300.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 300.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 327.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 300.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 300.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 478.44, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL C1889) IMPLANT/INSERT DEVICE, NOC - C1889 - 27201889", "code_information": [ { "code": "C1889", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 6405.84, "10th_percentile": 660.07, "90th_percentile": 6405.84, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1412.1, "10th_percentile": 1412.1, "90th_percentile": 1412.1, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 876.42, "10th_percentile": 752.99, "90th_percentile": 876.42, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 2538.76, "10th_percentile": 665.92, "90th_percentile": 5397.48, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 996.91, "10th_percentile": 309.32, "90th_percentile": 5997.2, "count": "1 through 10" } ] } ] }, { "description": "HC CHYLMD TRACH, DNA, AMP PROBE", "code_information": [ { "code": "87491", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 111.56, "discounted_cash": 35.0, "minimum": 33.468, "maximum": 111.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 67.4, "10th_percentile": 56.62, "90th_percentile": 89.25, "count": "34" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 42.62, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 34.1, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 53.67, "10th_percentile": 53.67, "90th_percentile": 56.85, "count": "26" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 60.04, "10th_percentile": 57.76, "90th_percentile": 60.04, "count": "37" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 111.56 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 84.25, "10th_percentile": 67.4, "90th_percentile": 89.25, "count": "16" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 77.83, "10th_percentile": 77.83, "90th_percentile": 77.83, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 59.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CALCULUS ASSAY,INFRARED SPECTR", "code_information": [ { "code": "82365", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 311.88, "discounted_cash": 12.0, "minimum": 12.5362, "maximum": 271.9594, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 167.66, "10th_percentile": 167.66, "90th_percentile": 167.66, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.67, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.54, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 167.84, "10th_percentile": 167.84, "90th_percentile": 171.06, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 67.69 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.06, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 67.69, "10th_percentile": 67.47, "90th_percentile": 219.56, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.82, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4411) OST SKN BARR EXTND =4SQ", "code_information": [ { "code": "A4411", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 7.0, "minimum": 7.0553, "maximum": 12.2781, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7.26, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.82, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7.06, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 7.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 7.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.28, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT MT-PHAL TOE DISLOC W ANES", "code_information": [ { "code": "28635", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2052.81, "discounted_cash": 1586.0, "minimum": 615.843, "maximum": 2052.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2052.81, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2052.81, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2052.81, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1729.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2052.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PLACE BILE CATH, CHOLANGIO, PERQ EXTERNAL", "code_information": [ { "code": "47533", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16418.8, "discounted_cash": 3532.0, "minimum": 3532.78, "maximum": 16418.8, "payers_information": [ { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5974.64, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13917.74, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16418.8, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13525.95, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3850.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3532.78, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC NM GASTRIC EMPTYING STUDY", "code_information": [ { "code": "78264", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1104.38, "discounted_cash": 394.0, "minimum": 331.314, "maximum": 1104.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 593.71, "10th_percentile": 593.71, "90th_percentile": 593.71, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1104.38, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1104.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1104.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1104.38 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT BIG TOE FX W MANIP", "code_information": [ { "code": "28495", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 300.94, "discounted_cash": 243.0, "minimum": 90.282, "maximum": 300.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 300.94, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 300.94, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 300.94, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 300.94, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "NON-MALIGNANT BREAST DISORDERS WITH CCMCC", "code_information": [ { "code": "600", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8969.0, "minimum": 6620.94, "maximum": 18821.5453, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8649.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 18821.55 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8649.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8649.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 8790.94 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8969.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6620.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8969.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8790.94 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8649.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8969.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8649.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11584.34 } ] } ] }, { "description": "Infliximab For IV Inj 100 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "57894016001", "type": "NDC" }, { "code": "J1745", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 31.0, "minimum": 30.2133, "maximum": 122.2891, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 122.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 37.77, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 30.21, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 65.62 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 31.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 31.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.83, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 31.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 31.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY UREA NITROGEN, QUAN", "code_information": [ { "code": "84520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 72.81, "discounted_cash": 3.0, "minimum": 3.8386, "maximum": 63.4903, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 46.6, "10th_percentile": 39.14, "90th_percentile": 46.6, "count": "12" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.8, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3.84, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 37.11, "10th_percentile": 37.11, "90th_percentile": 37.11, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 39.94, "10th_percentile": 39.18, "90th_percentile": 39.94, "count": "16" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.73 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 17.66, "10th_percentile": 17.66, "90th_percentile": 39.14, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 50.79, "10th_percentile": 50.79, "90th_percentile": 51.26, "count": "23" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC", "code_information": [ { "code": "064", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16342.0, "minimum": 13767.91, "maximum": 45494.806, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15723.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 36338.45 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 15723.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 15723.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 45061.36 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 16342.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13767.91 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16342.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 45061.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15723.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 16342.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15723.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22365.7 } ] } ] }, { "description": "SOFT TISSUE PROCEDURES WITH MCC", "code_information": [ { "code": "500", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 25117.0, "minimum": 21931.62, "maximum": 70451.1668, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24143.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 57187.43 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 24143.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24143.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 66072.33 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 25117.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21931.62 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 25117.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 66072.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24143.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 25117.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 24143.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 35197.89 } ] } ] }, { "description": "PNEUMOTHORAX WITH CC", "code_information": [ { "code": "200", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9408.0, "minimum": 7665.37, "maximum": 21408.5371, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9070.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 19864.18 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9070.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9070.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 13461.13 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9408.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7665.37 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9408.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13461.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9070.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 9408.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9070.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12226.06 } ] } ] }, { "description": "HC (SUP SHELL Q4130) STRATTICE TM", "code_information": [ { "code": "Q4130", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 126.52, "maximum": 605.4868, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC OP CARDIAC REHAB W CONT ECG MONIT PER SESSION", "code_information": [ { "code": "93798", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 160.31, "discounted_cash": 127.0, "minimum": 48.093, "maximum": 160.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 160.31, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 160.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 160.31, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 127.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 127.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 138.64, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 127.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 127.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 160.31, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L0462) TLSO 3MOD SACRO-SCAP PRE", "code_information": [ { "code": "L0462", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 1497.0, "minimum": 1455.4551, "maximum": 2532.8933, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1497.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1497.69, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1819.24, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1497.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1455.46, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1497.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1497.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1497.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1632.48, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1497.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1497.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1497.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1497.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1497.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2532.89, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC", "code_information": [ { "code": "871", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15821.0, "minimum": 13580.34, "maximum": 46859.9621, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 42184.71, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 35783.91, "10th_percentile": 20522.27, "90th_percentile": 36744.61, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15223.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 35100.66 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 15223.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "other", "standard_charge_dollar": 39873.96, "standard_charge_algorithm": "74.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 22041.89, "10th_percentile": 22041.89, "90th_percentile": 22041.89, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 15223.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 29846.72 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "other", "standard_charge_dollar": 46752.49, "standard_charge_algorithm": "87% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 35100.66, "10th_percentile": 35100.66, "90th_percentile": 35100.66, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 15821.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13580.34 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15821.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 29846.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 46859.96, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 18504.33, "10th_percentile": 18504.33, "90th_percentile": 18504.33, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15223.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 15821.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15223.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21603.86 } ] } ] }, { "description": "HC ENZYME CELL ACTIVITY", "code_information": [ { "code": "82657", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 380.63, "discounted_cash": 22.0, "minimum": 21.5448, "maximum": 331.9094, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 26.93, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 21.54, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 116.33 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37.49, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC VASOPNEUMATIC DEVICE THERAPY", "code_information": [ { "code": "97016", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 139.06, "discounted_cash": 11.0, "minimum": 11.1174, "maximum": 121.2603, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.44, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.9, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.12, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.47, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT ACETABULAR FX WO MANIP", "code_information": [ { "code": "27220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1005.0, "discounted_cash": 243.0, "minimum": 243.38, "maximum": 1005.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 958.82, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1005.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 931.83, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 411.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Neostigmine Methylsulfate Inj 1 MG/ML", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "00641614901", "type": "NDC" }, { "code": "J2710", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.763, "maximum": 1.763, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 146.93, "10th_percentile": 142.82, "90th_percentile": 289.75, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.76 } ] } ] }, { "description": "POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES", "code_information": [ { "code": "769", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13899.0, "minimum": 9525.83, "maximum": 30534.4156, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13379.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 30534.42 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13379.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13379.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 26441.02 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 13899.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9525.83 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13899.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26441.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13379.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 13899.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13379.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18793.41 } ] } ] }, { "description": "HC INJ NERV BLCK,OTHR PERIPH NERV", "code_information": [ { "code": "64450", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1647.81, "discounted_cash": 696.0, "minimum": 494.343, "maximum": 1647.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1647.81, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1647.81, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1647.81, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 759.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1177.9, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REPLACE AORTIC VALVE PERQ FEMORAL ARTRY APPROACH", "code_information": [ { "code": "33361", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19628.8, "minimum": 5888.64, "maximum": 19628.8, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 19628.8 } ] } ] }, { "description": "HC MRI LOWER EXTREM JT, W/O CONTRAST", "code_information": [ { "code": "73721", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2882.5, "discounted_cash": 235.0, "minimum": 235.42, "maximum": 2513.54, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1434.55, "10th_percentile": 1291.42, "90th_percentile": 1434.55, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 927.46, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1126.65, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 901.35, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1269.49 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 563.85, "10th_percentile": 563.85, "90th_percentile": 563.85, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 256.61, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 1878.58, "10th_percentile": 1878.58, "90th_percentile": 1878.58, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "INTRAOCULAR PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "117", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9299.0, "minimum": 7005.77, "maximum": 23462.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8965.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 19603.97 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8965.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8965.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 23461.99 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9299.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7005.77 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9299.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23462.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8965.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 9299.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8965.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12065.91 } ] } ] }, { "description": "HC CISTERNAL/LATERAL C1-C2 PUNCTURE W/O INJ SPX", "code_information": [ { "code": "61050", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1102.19, "discounted_cash": 302.0, "minimum": 302.87, "maximum": 1102.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1102.19, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1102.19, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1102.19, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 330.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 512.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Hydrocortisone Sodium Succinate PF For Inj 100 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00009001103", "type": "NDC" }, { "code": "J1720", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 44.247, "maximum": 44.247, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.25 } ] } ] }, { "description": "HC CLSD TREAT HUM SUPRACONDYLR FX W MANIP", "code_information": [ { "code": "24535", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5930.94, "discounted_cash": 1586.0, "minimum": 1586.61, "maximum": 5930.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5930.94, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5930.94, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5930.94, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1729.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2683.27, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DEBRIDEMENT OF NAILS, 6 OR MORE", "code_information": [ { "code": "11721", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 325.63, "discounted_cash": 58.0, "minimum": 58.2, "maximum": 283.9494, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 278.53, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 222.83, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.44, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 98.43, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 229.28, "additional_payer_notes": "393.96% of Medicare Rates" } ] } ] }, { "description": "REHABILITATION WITHOUT CCMCC", "code_information": [ { "code": "946", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9769.0, "minimum": 7727.66, "maximum": 24800.51, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9417.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 20722.49 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9417.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9417.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 24800.51 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9769.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7727.66 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9769.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24800.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9417.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 9769.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9417.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12754.34 } ] } ] }, { "description": "HC CLOSTRIDIUM AG, EIA", "code_information": [ { "code": "87324", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 270.31, "discounted_cash": 11.0, "minimum": 11.6422, "maximum": 235.7103, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.55, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.64, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 62.86 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.06, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.26, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CONCOMITANT AORTIC AND MITRAL VALVE PROCEDURES", "code_information": [ { "code": "212", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 83749.0, "minimum": 14608.7, "maximum": 196493.2471, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 80404.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 196493.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 80404.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 80404.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 14608.71 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 83749.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75400.28 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 83749.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14608.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 80404.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 83749.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 80404.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 120938.26 } ] } ] }, { "description": "REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CCMCC", "code_information": [ { "code": "468", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21947.0, "minimum": 18156.72, "maximum": 54734.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 21102.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 49655.92 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 21102.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 21102.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 54734.9 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 21947.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18156.72 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21947.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 54734.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 21102.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 21947.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 21102.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30562.38 } ] } ] }, { "description": "HC ANGIO VISCERAL SELECTV/SUBSELEC", "code_information": [ { "code": "75726", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9352.5, "discounted_cash": 5490.0, "minimum": 681.5709, "maximum": 9352.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9352.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9352.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9352.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1260.75, "10th_percentile": 1260.75, "90th_percentile": 1260.75, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 681.57 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5984.62, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9285.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF IRON", "code_information": [ { "code": "83540", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 96.88, "discounted_cash": 6.0, "minimum": 6.2875, "maximum": 84.4794, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 62.0, "10th_percentile": 52.08, "90th_percentile": 62.0, "count": "37" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.86, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6.29, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 49.37, "10th_percentile": 49.37, "90th_percentile": 49.37, "count": "21" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 52.13, "10th_percentile": 52.13, "90th_percentile": 53.13, "count": "76" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.95 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 28.92, "10th_percentile": 28.92, "90th_percentile": 62.0, "count": "14" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 67.58, "10th_percentile": 33.95, "90th_percentile": 68.2, "count": "125" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.94, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF FOR HVA", "code_information": [ { "code": "83150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 574.38, "discounted_cash": 22.0, "minimum": 21.778, "maximum": 500.8594, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 21.78, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 117.59 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37.9, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PR REFOREARM TEND/MUSC,FLEX,PRIM,EA", "code_information": [ { "code": "25260", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15120.6, "discounted_cash": 3228.0, "minimum": 3228.48, "maximum": 15120.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12718.92, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15120.6, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12360.88, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3519.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5460.01, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CCMCC", "code_information": [ { "code": "929", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 25543.0, "minimum": 22012.6, "maximum": 58199.3407, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24552.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 58199.34 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 24552.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24552.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 44358.01 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 25543.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22012.6 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 25543.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 44358.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24552.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 25543.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 24552.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 35820.71 } ] } ] }, { "description": "HC XRAY UPPER GI AIR CONTRAST", "code_information": [ { "code": "74246", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1179.69, "discounted_cash": 173.0, "minimum": 173.07, "maximum": 1028.6897, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 292.7, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 712.2, "10th_percentile": 712.2, "90th_percentile": 712.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 681.83, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 828.26, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 662.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 598.34, "10th_percentile": 598.34, "90th_percentile": 598.34, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 851.17 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 822.95, "10th_percentile": 822.95, "90th_percentile": 822.95, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY OPER CHOLANGIO ADDNL SET", "code_information": [ { "code": "74301", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1532.19, "minimum": 157.9777, "maximum": 1336.0697, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 157.98 } ] } ] }, { "description": "HC X-RAY NOSE-RECTUM CHILD F.B.", "code_information": [ { "code": "76010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 436.88, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 410.9481, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 221.59, "10th_percentile": 221.59, "90th_percentile": 221.59, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 410.95, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 184.26 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "310", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5353.0, "minimum": 3872.48, "maximum": 13321.3498, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5179.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 10229.34 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 5179.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 5179.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 9083.19 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "other", "standard_charge_dollar": 13290.8, "standard_charge_algorithm": "87% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 10110.08, "10th_percentile": 10110.08, "90th_percentile": 10110.08, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 5353.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3872.48 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5353.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9083.19 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 13321.35, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 13906.12, "10th_percentile": 13906.12, "90th_percentile": 13906.12, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5179.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 5353.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 5179.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6295.98 } ] } ] }, { "description": "HC MICROVOLT T-WAVE ASSESS VENTRICULAR ARRHYTHMIAS", "code_information": [ { "code": "93025", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 894.06, "discounted_cash": 126.0, "minimum": 126.95, "maximum": 779.6203, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 500.13, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 607.54, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 486.05, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 138.38, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 214.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "PANCREAS TRANSPLANT", "code_information": [ { "code": "010", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 55621.0, "minimum": 53414.4, "maximum": 155186.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 53414.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 129663.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 53414.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 53414.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 155185.81 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 55621.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55183.76 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 55621.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 155186.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 53414.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 55621.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 53414.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 79805.84 } ] } ] }, { "description": "OTHER DISORDERS OF NERVOUS SYSTEM WITH CC", "code_information": [ { "code": "092", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8828.0, "minimum": 7327.61, "maximum": 26516.4272, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8513.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 18485.45 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8513.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8513.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 18939.88 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8828.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7327.61 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8828.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18939.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8513.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8828.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8513.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11377.48 } ] } ] }, { "description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CCMCC", "code_information": [ { "code": "479", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15185.0, "minimum": 12290.9, "maximum": 66370.0695, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14613.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 33590.03 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14613.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14613.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 39662.49 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 15185.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12290.9 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15185.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 39662.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14613.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 15185.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14613.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20674.09 } ] } ] }, { "description": "HC CT SCAN MAXILLOFACIAL AREA COMBO", "code_information": [ { "code": "70488", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2499.06, "discounted_cash": 173.0, "minimum": 173.07, "maximum": 2179.1803, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 681.83, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 828.26, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 662.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1137.86 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 292.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC OPHTHALMIC ULTRASOUND DX B-SCAN W/WO A-SCAN", "code_information": [ { "code": "76512", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 677.81, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 591.0503, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 157.98 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF SEROTONIN", "code_information": [ { "code": "84260", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 390.94, "discounted_cash": 30.0, "minimum": 30.1064, "maximum": 340.8997, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 37.63, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 30.11, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 162.56 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.77, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52.39, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CARDIOVERSION, ELECTIVE;INTERN", "code_information": [ { "code": "92961", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1796.25, "discounted_cash": 652.0, "minimum": 538.875, "maximum": 1796.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 652.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1796.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1796.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 652.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1796.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 652.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 652.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 652.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 710.84, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 652.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 652.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 652.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 652.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 652.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1102.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL C9352) MICROPOROUS COLL IMPLANTBLE TUBE CM", "code_information": [ { "code": "C9352", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2276.334, "maximum": 2276.334, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2276.33 } ] } ] }, { "description": "HC OPEN TX FRACTURE GREAT TOE/PHALANX/PHALANGES", "code_information": [ { "code": "28505", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4149.69, "discounted_cash": 3228.0, "minimum": 1244.907, "maximum": 4149.69, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4149.69, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4149.69, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4149.69, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4149.69, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3519.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC CYSTATIN C", "code_information": [ { "code": "82610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 334.69, "discounted_cash": 18.0, "minimum": 17.9977, "maximum": 291.8497, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 82.78, "10th_percentile": 82.78, "90th_percentile": 82.78, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.5, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 18.0, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 170.56, "10th_percentile": 170.56, "90th_percentile": 170.56, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 97.18 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.19, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 97.18, "10th_percentile": 97.18, "90th_percentile": 97.18, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.32, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4351) STRAIGHT TIP URINE CATHETER", "code_information": [ { "code": "A4351", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 2.0, "minimum": 2.5072, "maximum": 4.3633, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2.58, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.13, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2.51, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.81, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.36, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY HEEL", "code_information": [ { "code": "73650", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 465.0, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 410.9481, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 280.8, "10th_percentile": 280.8, "90th_percentile": 280.8, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 410.95, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 272.87, "10th_percentile": 272.87, "90th_percentile": 272.87, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 184.26 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6255) ABSORPT DRG >16<=48 IN W/BDR - A6255 - 27200144", "code_information": [ { "code": "A6255", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 4.0, "minimum": 4.2176, "maximum": 7.3398, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.34, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.27, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.22, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 4.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY KNEE BILAT STANDING", "code_information": [ { "code": "73565", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 390.31, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 390.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 390.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 280.82 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "FULL TERM NEONATE WITH MAJOR PROBLEMS", "code_information": [ { "code": "793", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 32759.0, "minimum": 11182.2056, "maximum": 90175.33, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 14961.7, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 1571.33, "10th_percentile": 1571.33, "90th_percentile": 3089.87, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 31476.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 75344.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 31476.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 31476.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 90175.33 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 32759.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28865.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 32759.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 90175.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 16619.88, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 4746.44, "10th_percentile": 4746.44, "90th_percentile": 4746.44, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 31476.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 32759.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 31476.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 46372.96 } ] } ] }, { "description": "HC X-RAY COLON AIR CONTRAST", "code_information": [ { "code": "74280", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1600.63, "discounted_cash": 173.0, "minimum": 173.07, "maximum": 1409.8975, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 681.83, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 828.26, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 662.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1409.9 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 292.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY SKULL 4+ VW", "code_information": [ { "code": "70260", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 775.0, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 675.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 274.94 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Rabies Virus Vaccine, HDC For Inj Susp", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "49281025251", "type": "NDC" }, { "code": "90675", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 315.0, "minimum": 304.8342, "maximum": 1241.8368, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1461.1, "10th_percentile": 1461.1, "90th_percentile": 1461.1, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1241.84, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 381.03, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 304.83, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1690.26, "10th_percentile": 1690.26, "90th_percentile": 1690.26, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 682.99 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 315.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 315.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 343.59, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 315.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 315.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 533.1, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF HAPTOGLOBIN, QUANT", "code_information": [ { "code": "83010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 190.31, "discounted_cash": 12.0, "minimum": 12.2252, "maximum": 165.9503, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 56.23, "10th_percentile": 56.23, "90th_percentile": 56.23, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.28, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.23, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 66.01 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.71, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 12.58, "10th_percentile": 12.58, "90th_percentile": 132.76, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.28, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT TAR-METATAR DISLOC WO ANES", "code_information": [ { "code": "28600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 404.06, "discounted_cash": 243.0, "minimum": 121.218, "maximum": 404.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ANALYZE NEUROSTIM,COMPLX/PROG", "code_information": [ { "code": "95972", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1094.38, "discounted_cash": 93.0, "minimum": 93.8, "maximum": 954.2994, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 369.53, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 448.9, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 359.13, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 93.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 93.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 102.24, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 93.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 93.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 158.63, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6451) MOD COMPRES BAND W>=3<5/YD", "code_information": [ { "code": "A6451", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 2.0, "minimum": 2.4295, "maximum": 4.228, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.04, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2.43, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REVIS TRANSVEN INTRAHEP PORTOSYS SHUNT", "code_information": [ { "code": "37183", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 66127.2, "discounted_cash": 5615.0, "minimum": 5615.88, "maximum": 57662.9184, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 22124.32, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 26875.92, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 21501.52, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6121.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9497.58, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ECHO HEART XTHORACIC,LIMITED - C8924 - 48300002", "code_information": [ { "code": "C8924", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1870.94, "discounted_cash": 344.0, "minimum": 344.22, "maximum": 1647.3337, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1356.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1647.33, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1317.92, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY SPINE ONE VIEW", "code_information": [ { "code": "72020", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 426.56, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 410.9481, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 410.95, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 146.29 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF APOLIPOPROTEIN", "code_information": [ { "code": "82172", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 255.0, "discounted_cash": 21.0, "minimum": 20.4953, "maximum": 222.36, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 163.2, "10th_percentile": 145.4, "90th_percentile": 163.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.62, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 20.5, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 154.47, "10th_percentile": 85.04, "90th_percentile": 245.72, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 137.23, "10th_percentile": 89.81, "90th_percentile": 163.13, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 110.66 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 94.27, "10th_percentile": 94.27, "90th_percentile": 94.27, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.99, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 116.41, "10th_percentile": 110.66, "90th_percentile": 211.46, "count": "12" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.67, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L8002) BRST PRSTH BRA & BILAT FORM", "code_information": [ { "code": "L8002", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 198.0, "minimum": 192.6788, "maximum": 335.3142, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 198.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 198.27, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 240.84, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 198.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 192.68, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 198.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 198.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 198.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 216.11, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 198.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 198.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 198.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 198.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 198.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 335.31, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC NASAL SMEAR FOR EOSINOPHILS", "code_information": [ { "code": "89190", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 121.88, "discounted_cash": 5.0, "minimum": 5.6267, "maximum": 106.2794, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.79, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.03, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.63, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.79, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INSERT PULSE GENER SINGLE CHMBR", "code_information": [ { "code": "33212", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 32764.1, "discounted_cash": 8165.0, "minimum": 8165.34, "maximum": 32764.1, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8900.22, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13809.22, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 32168.17, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 32764.1, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8165.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 31262.64, "additional_payer_notes": "382.87% of Medicare Rates" } ] } ] }, { "description": "MAJOR ESOPHAGEAL DISORDERS WITH MCC", "code_information": [ { "code": "368", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13155.0, "minimum": 11558.62, "maximum": 29331.764, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12665.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 28765.38 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12665.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12665.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 22146.86 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 13155.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11558.62 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13155.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22146.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12665.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 13155.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12665.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17704.6 } ] } ] }, { "description": "HC PERQ SAC AGMNTJ UNI W/WO BALO/MCHNL DEV 1/> NDL", "code_information": [ { "code": "0200T", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25034.1, "discounted_cash": 7159.0, "minimum": 7159.72, "maximum": 25034.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 25034.1, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 25034.1, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 25034.1, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7804.09, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7159.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12108.52, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CHANGE EXT TRANSNEPH URETER STENT W/ FLUORO", "code_information": [ { "code": "50387", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4355.31, "discounted_cash": 2062.0, "minimum": 1306.593, "maximum": 4355.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4355.31, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4355.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4355.31, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2248.21, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3488.24, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT BIMALLEOLAR ANKLE FX W MANIP", "code_information": [ { "code": "27810", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 560.0, "discounted_cash": 1586.0, "minimum": 168.0, "maximum": 560.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 560.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 560.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 560.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 560.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 560.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 560.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 560.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 560.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 560.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 560.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 560.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 560.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 560.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 560.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 560.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "VAGINAL DELIVERY WITH STERILIZATION ANDOR D&C WITHOUT CCMCC", "code_information": [ { "code": "798", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8327.0, "minimum": 6701.23, "maximum": 22057.4079, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 19856.73, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 14961.44, "10th_percentile": 14961.44, "90th_percentile": 14961.44, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8032.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 17294.64 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8032.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8032.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8327.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6701.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8327.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8032.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8327.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8032.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10644.56 } ] } ] }, { "description": "HC PUNCTURE DRAINAGE OF LESION", "code_information": [ { "code": "10160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 410.31, "discounted_cash": 401.0, "minimum": 123.093, "maximum": 410.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 410.31, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 410.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 410.31, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 410.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 410.31, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF VITAMIN B-1", "code_information": [ { "code": "84425", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 351.88, "discounted_cash": 21.0, "minimum": 20.6313, "maximum": 306.8394, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 225.2, "10th_percentile": 225.2, "90th_percentile": 225.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.79, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 20.63, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 179.32, "10th_percentile": 179.32, "90th_percentile": 179.32, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 193.0, "10th_percentile": 189.37, "90th_percentile": 193.0, "count": "13" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 111.4 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 94.9, "10th_percentile": 94.9, "90th_percentile": 225.2, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.14, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 245.47, "10th_percentile": 245.47, "90th_percentile": 247.72, "count": "16" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.9, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC TETANUS ANTIBODY", "code_information": [ { "code": "86774", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 215.94, "discounted_cash": 14.0, "minimum": 14.3826, "maximum": 188.2997, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.8, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.38, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 77.66 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 14.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 143.44, "10th_percentile": 143.44, "90th_percentile": 143.44, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 14.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.03, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4315) CATH W/DRAINAGE 2-WAY SILCNE", "code_information": [ { "code": "A4315", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 31.0, "minimum": 31.049, "maximum": 54.0338, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 31.95, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 38.81, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 31.05, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 31.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 31.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.83, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 31.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 31.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 54.03, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC TRANSCATHETER BIOPSY", "code_information": [ { "code": "37200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2220.94, "discounted_cash": 5490.0, "minimum": 666.282, "maximum": 2220.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2220.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2220.94, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2220.94, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2220.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2220.94, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2220.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2220.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2220.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2220.94, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2220.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2220.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2220.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2220.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2220.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2220.94, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CSF LEAKAGE DETECTION & LOCALIZATION", "code_information": [ { "code": "78650", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1237.5, "discounted_cash": 1277.0, "minimum": 371.25, "maximum": 1237.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1237.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1237.5, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1237.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1237.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1237.5, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1237.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1237.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1237.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1237.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1237.5, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1237.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1237.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1237.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1237.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1237.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1237.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC COAGULATION TIME, ACTIVATED", "code_information": [ { "code": "85347", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 58.44, "discounted_cash": 4.0, "minimum": 4.1593, "maximum": 50.9597, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.2, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.46 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.67, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.24, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Prednisolone Sod Phosphate Oral Soln 15 MG/5ML (Base Equiv)", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "00121475905", "type": "NDC" }, { "code": "J7510", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.032, "maximum": 1.032, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.03 } ] } ] }, { "description": "MAJOR BLADDER PROCEDURES WITH MCC", "code_information": [ { "code": "653", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 40568.0, "minimum": 38583.65, "maximum": 93898.1166, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 38970.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 93898.12 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 38970.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 38970.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 79284.07 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 40568.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38583.65 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 40568.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 79284.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 38970.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 40568.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 38970.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 57792.7 } ] } ] }, { "description": "INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH CC", "code_information": [ { "code": "758", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8493.0, "minimum": 7054.91, "maximum": 26007.8726, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8192.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 17690.37 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8192.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8192.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 11717.36 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8493.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7054.91 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8493.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11717.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8192.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8493.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8192.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10888.12 } ] } ] }, { "description": "HC PERCUT MECH THROMBECTOMY, VENOUS, REPEAT", "code_information": [ { "code": "37188", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12674.1, "discounted_cash": 3115.0, "minimum": 3115.49, "maximum": 12674.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12273.78, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 12674.1, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11928.28, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5268.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INSERT ATRIAL PM W TRANSVENOUS ELECTRODE", "code_information": [ { "code": "33206", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 38988.8, "discounted_cash": 10313.0, "minimum": 10313.01, "maximum": 38988.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 38988.8, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 38988.8, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 38988.8, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11241.18, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10313.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17441.36, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CCMCC", "code_information": [ { "code": "848", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7508.0, "minimum": 5667.88, "maximum": 15348.5221, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7246.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 15348.52 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7246.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7246.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 10961.4 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7508.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5667.88 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7508.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10961.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7246.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7508.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7246.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9446.75 } ] } ] }, { "description": "OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH CC", "code_information": [ { "code": "844", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10306.0, "minimum": 8272.37, "maximum": 21998.2232, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9932.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 21998.22 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9932.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9932.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 20582.33 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 10306.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8272.37 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10306.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20582.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9932.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 10306.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9932.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13539.53 } ] } ] }, { "description": "HC EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT", "code_information": [ { "code": "34705", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5869.38, "minimum": 1760.814, "maximum": 5869.38, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 5869.38 } ] } ] }, { "description": "Aminocaproic Acid Inj 250 MG/ML", "drug_information": { "unit": 20.0, "type": "ML" }, "code_information": [ { "code": "00409434616", "type": "NDC" }, { "code": "J0281", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2.795, "maximum": 2.795, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2.8 } ] } ] }, { "description": "HC ASSAY OF SIROLIMUS", "code_information": [ { "code": "80195", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 177.81, "discounted_cash": 13.0, "minimum": 13.3428, "maximum": 155.0503, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.68, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13.34, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 72.04 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.97, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ARC RBC ANTIBODY IDENTIFICATION", "code_information": [ { "code": "86870", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 455.31, "discounted_cash": 353.0, "minimum": 136.593, "maximum": 455.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 244.78, "10th_percentile": 244.78, "90th_percentile": 244.78, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 353.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 455.31, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 455.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 353.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 455.31, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 270.81 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 353.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 353.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 353.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 385.51, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 353.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 353.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 317.63, "10th_percentile": 317.63, "90th_percentile": 317.63, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 353.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 353.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 353.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 455.31, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "PERITONEAL ADHESIOLYSIS WITH CC", "code_information": [ { "code": "336", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17085.0, "minimum": 14619.93, "maximum": 50074.5336, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16436.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 38103.87 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 16436.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 16436.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 37768.7 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 17085.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14619.93 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17085.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 37768.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16436.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 17085.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16436.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23452.29 } ] } ] }, { "description": "Methacholine Chloride Inhal For Soln 100 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "64281010000", "type": "NDC" }, { "code": "J7674", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 3.5045, "maximum": 3.5045, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.5 } ] } ] }, { "description": "HC SURG PATH,LEVEL IV", "code_information": [ { "code": "88305", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 462.19, "discounted_cash": 51.0, "minimum": 51.42, "maximum": 403.0297, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 202.57, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 246.08, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 196.87, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 235.53, "10th_percentile": 235.53, "90th_percentile": 1848.75, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 231.82 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 140.85, "10th_percentile": 140.63, "90th_percentile": 422.55, "count": "56" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.05, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 231.06, "10th_percentile": 231.06, "90th_percentile": 322.42, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 248.47, "10th_percentile": 248.47, "90th_percentile": 566.73, "count": "96" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC DEBRIDE SKIN SUB-Q TISS =<20 SQ CM", "code_information": [ { "code": "11042", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 591.56, "discounted_cash": 401.0, "minimum": 177.468, "maximum": 591.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 591.56, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 591.56, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 591.56, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 437.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 591.56, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY ALKALINE PHOSPHATASE ,ISOENZYMES", "code_information": [ { "code": "84080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 310.63, "discounted_cash": 14.0, "minimum": 14.3632, "maximum": 270.8694, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.95, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.36, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 136.8, "10th_percentile": 136.8, "90th_percentile": 136.8, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 317.6, "10th_percentile": 317.6, "90th_percentile": 317.6, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 77.55 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.11, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 218.68, "10th_percentile": 218.68, "90th_percentile": 218.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC RO SET RADN THERAPY FIELD COMPLEX", "code_information": [ { "code": "77290", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2524.38, "discounted_cash": 369.0, "minimum": 369.45, "maximum": 2201.2594, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 369.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1455.49, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1768.08, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 369.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1414.51, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 369.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 369.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 369.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 402.7, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 369.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 369.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 369.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 369.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 369.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 624.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC", "code_information": [ { "code": "847", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10997.0, "minimum": 8794.93, "maximum": 36011.0346, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10594.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 23638.96 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10594.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10594.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 19900.41 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 10997.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8794.93 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10997.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19900.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10594.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 10997.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10594.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14549.38 } ] } ] }, { "description": "HC (SUP SHELL A4344) CATH INDW FOLEY 2 WAY SILICN - A4344 - 27200065", "code_information": [ { "code": "A4344", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 22.0, "minimum": 22.1668, "maximum": 38.5763, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 27.71, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.86, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.58, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ELECTRICAL STIMULATION EA 15 MIN", "code_information": [ { "code": "97032", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 113.44, "discounted_cash": 14.0, "minimum": 13.6927, "maximum": 98.9197, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.09, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.12, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13.69, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 14.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.36, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 14.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.83, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARREST, UNEXPLAINED WITH CC", "code_information": [ { "code": "297", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5869.0, "minimum": 4875.38, "maximum": 13710.52, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5674.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 11456.28 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 5674.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 5674.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 13710.52 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 5869.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4875.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5869.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13710.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5674.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 5869.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 5674.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7051.15 } ] } ] }, { "description": "HC CHLAMYDIA, ANTIBODY", "code_information": [ { "code": "86631", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 98.44, "discounted_cash": 11.0, "minimum": 11.4867, "maximum": 85.8397, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.82, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.36, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.49, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 62.02 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.99, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Pentobarbital Sodium Inj 50 MG/ML", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "25021067650", "type": "NDC" }, { "code": "J2515", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 36.0, "minimum": 36.838, "maximum": 145.127, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 145.13, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 64.16, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 51.33, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 48.59 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.15, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.3, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC FRESH FROZEN PLASMA 24 PRODUCT", "code_information": [ { "code": "P9059", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 336.25, "discounted_cash": 73.0, "minimum": 73.41, "maximum": 336.25, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 73.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 80.02, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 73.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 73.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 73.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 73.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 73.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 124.15, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 73.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 289.21, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 336.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 73.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 281.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 206.22, "10th_percentile": 206.22, "90th_percentile": 206.22, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 73.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 73.41, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC HISTOPLASMA CAPSUL AG, EIA", "code_information": [ { "code": "87385", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 207.81, "discounted_cash": 13.0, "minimum": 12.8764, "maximum": 181.2103, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.09, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 69.53 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.44, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CCMCC", "code_information": [ { "code": "842", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8732.0, "minimum": 7280.55, "maximum": 31557.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8421.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 18257.77 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8421.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8421.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 31557.37 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8732.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7280.55 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8732.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 31557.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8421.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8732.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8421.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11237.35 } ] } ] }, { "description": "HC (SUP SHELL Q4176) NEOPATCH OR THERION, 1 SQ CM", "code_information": [ { "code": "Q4176", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 126.52, "maximum": 605.4868, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 141.73 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "072", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6799.0, "minimum": 5192.38, "maximum": 24319.8903, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6566.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 13664.41 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6566.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6566.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 13198.1 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6799.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5192.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6799.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13198.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6566.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 6799.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6566.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8410.21 } ] } ] }, { "description": "HC INSERT TRANSVEN INTRAHEP PORTOSYS SHUNT", "code_information": [ { "code": "37182", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 66127.2, "discounted_cash": 18087.0, "minimum": 18087.87, "maximum": 66127.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 66127.2, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 54000.88, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 66127.2, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19715.78, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18087.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30590.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A5073) URINARY POUCH ON BARR W/FLNG", "code_information": [ { "code": "A5073", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 4.0, "minimum": 4.4023, "maximum": 7.6611, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.53, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.4, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 4.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.94, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 4.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.66, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "PLEURAL EFFUSION WITH MCC", "code_information": [ { "code": "186", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12901.0, "minimum": 10935.7, "maximum": 28161.8456, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12421.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 28161.85 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12421.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12421.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 25546.72 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12901.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10935.7 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12901.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25546.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12421.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 12901.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12421.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17333.14 } ] } ] }, { "description": "HC (SUP SHELL A4340) INDWELLING CATHETER SPECIAL - A4340 - 27200064", "code_information": [ { "code": "A4340", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 45.0, "minimum": 43.974, "maximum": 76.5268, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 45.25, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 54.97, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 43.97, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 45.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 45.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.32, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 45.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 45.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 76.53, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ARC RBC ANTIBODY ELUTION", "code_information": [ { "code": "86860", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 707.5, "discounted_cash": 168.0, "minimum": 168.1, "maximum": 707.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 662.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 707.5, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 643.6, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 197.14 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 183.23, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 284.29, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "FRACTURES OF HIP AND PELVIS WITH MCC", "code_information": [ { "code": "535", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10798.0, "minimum": 9204.68, "maximum": 27725.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10403.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 23165.53 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10403.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10403.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 27724.97 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 10798.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9204.68 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10798.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 27725.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10403.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 10798.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10403.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14257.99 } ] } ] }, { "description": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "836", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10322.0, "minimum": 8599.06, "maximum": 47613.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9947.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 22036.17 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 9947.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 9947.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 47613.7 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 10322.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8599.06 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10322.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 47613.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9947.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 10322.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9947.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13562.89 } ] } ] }, { "description": "HC CT SCAN ABDOMEN/PELVIS WO CONTRAST", "code_information": [ { "code": "74176", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2415.63, "discounted_cash": 235.0, "minimum": 235.42, "maximum": 2106.4294, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1126.65, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 901.35, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1139.47, "10th_percentile": 1139.47, "90th_percentile": 1286.79, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 933.13 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 413.74, "10th_percentile": 413.39, "90th_percentile": 413.74, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 256.61, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 1354.87, "10th_percentile": 1354.87, "90th_percentile": 1354.87, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 984.98, "10th_percentile": 984.98, "90th_percentile": 1172.6, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 927.46, "additional_payer_notes": "393.96% of Medicare Rates" } ] } ] }, { "description": "Cyclosporine Cap 100 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00078024161", "type": "NDC" }, { "code": "J7502", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 4.343, "maximum": 4.343, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.34 } ] } ] }, { "description": "HC CLSD TREAT STERNO-CLAV DISLOC WO MANIP", "code_information": [ { "code": "23520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 300.94, "discounted_cash": 1586.0, "minimum": 90.282, "maximum": 300.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 300.94, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 300.94, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 300.94, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 300.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 300.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 300.94, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 300.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 300.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 300.94, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INSULIN ANTIBODIES", "code_information": [ { "code": "86337", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 400.63, "discounted_cash": 21.0, "minimum": 20.8062, "maximum": 349.3494, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 21.41, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 26.01, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 112.34 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 21.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 21.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.34, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 21.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC HFE GENE", "code_information": [ { "code": "81256", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 419.69, "discounted_cash": 65.0, "minimum": 63.5168, "maximum": 365.9697, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 65.36, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 79.39, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 63.52, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 342.96 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 65.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 65.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 71.24, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 65.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 65.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 110.54, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L1902) AFO ANKLE GAUNTLET PRE OTS", "code_information": [ { "code": "L1902", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 105.0, "minimum": 102.6804, "maximum": 178.6922, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 105.66, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 128.35, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 102.68, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 105.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 105.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 115.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 105.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 105.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 178.69, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH", "code_information": [ { "code": "83521", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 118.13, "discounted_cash": 17.0, "minimum": 16.783, "maximum": 103.0094, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.98, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 16.78, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 90.62 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.82, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF GASTRIN", "code_information": [ { "code": "82941", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 190.31, "discounted_cash": 17.0, "minimum": 17.1328, "maximum": 165.9503, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.42, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 17.13, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 104.38, "10th_percentile": 104.38, "90th_percentile": 104.38, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 92.51 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.22, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.82, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Dicyclomine HCl Inj 10 MG/ML", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "70069044101", "type": "NDC" }, { "code": "J0500", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 27.649, "maximum": 27.649, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.65 } ] } ] }, { "description": "HC PERQ LUMBOSACRAL INJ", "code_information": [ { "code": "22511", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16164.4, "discounted_cash": 3228.0, "minimum": 3228.48, "maximum": 15450.5367, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12718.92, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15450.54, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12360.88, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3519.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3228.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5460.01, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY FOOT 2 VW", "code_information": [ { "code": "73620", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 342.81, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 342.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 342.81, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 201.15, "10th_percentile": 201.15, "90th_percentile": 201.15, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 187.24 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MRA PELVIS W CONTRAST - C8918 - 61800007", "code_information": [ { "code": "C8918", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2630.0, "discounted_cash": 344.0, "minimum": 344.22, "maximum": 2293.36, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1356.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1647.33, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1317.92, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC UNLISTED ENDOCRINE PX DX NUCLEAR MEDICINE", "code_information": [ { "code": "78099", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 975.0, "discounted_cash": 394.0, "minimum": 292.5, "maximum": 975.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 975.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 975.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 975.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "ALLERGIC REACTIONS WITH MCC", "code_information": [ { "code": "915", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13837.0, "minimum": 12028.58, "maximum": 39230.9772, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13319.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 30386.24 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13319.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13319.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 32890.04 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 13837.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12028.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13837.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32890.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13319.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 13837.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13319.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18702.22 } ] } ] }, { "description": "HC DRUG TST PRSMV READ INSTRMNT ASSTD DIR OPT OBS", "code_information": [ { "code": "80306", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 199.69, "discounted_cash": 17.0, "minimum": 16.6567, "maximum": 174.1297, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.14, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.82, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 16.66, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 89.94 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 17.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 17.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 17.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.99, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PCA3/KLK3 PROSTATE SPECIFIC ANTIGEN RATIO", "code_information": [ { "code": "81313", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1597.81, "discounted_cash": 255.0, "minimum": 247.8576, "maximum": 1393.2903, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 255.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 255.05, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 309.81, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 255.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 247.86, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1338.3 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 255.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 255.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 255.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 278.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 255.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 255.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 255.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 255.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 255.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 431.34, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INSERT NON-TUNNEL CV CATH =>5 YR", "code_information": [ { "code": "36556", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3466.56, "discounted_cash": 3115.0, "minimum": 1039.968, "maximum": 3466.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3466.56, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3466.56, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3466.56, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3466.56, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL C1759) CATH, INTRA ECHOCARDIOGRAPHY", "code_information": [ { "code": "C1759", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1172.14, "10th_percentile": 1172.14, "90th_percentile": 2793.0, "count": "1 through 10" } ] } ] }, { "description": "HC X-RAY RETROGRADE PYELOGRAM", "code_information": [ { "code": "74420", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1925.0, "discounted_cash": 344.0, "minimum": 344.22, "maximum": 1678.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 976.25, "10th_percentile": 976.25, "90th_percentile": 976.25, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1356.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1647.33, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1317.92, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 473.86 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 1113.68, "10th_percentile": 1113.68, "90th_percentile": 1180.56, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CT SCAN CERV SPINE CONTRAST", "code_information": [ { "code": "72126", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3257.5, "discounted_cash": 344.0, "minimum": 344.22, "maximum": 2840.54, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1356.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1647.33, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1317.92, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1017.93 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "LIVER TRANSPLANT WITH MCC OR INTESTINAL TRANSPLANT", "code_information": [ { "code": "005", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 79463.0, "minimum": 73708.01, "maximum": 233541.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 76291.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 186309.09 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 76291.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 76291.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 233540.52 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 79463.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73708.01 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 79463.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 233541.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 76291.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 79463.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 76291.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 114670.08 } ] } ] }, { "description": "HC ASSAY OF TOTAL THYROXINE", "code_information": [ { "code": "84436", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 134.06, "discounted_cash": 6.0, "minimum": 6.6763, "maximum": 116.9003, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 85.8, "10th_percentile": 85.8, "90th_percentile": 85.8, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.34, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 68.32, "10th_percentile": 68.32, "90th_percentile": 68.32, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 73.53, "10th_percentile": 73.53, "90th_percentile": 73.53, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.05 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 30.71, "10th_percentile": 30.71, "90th_percentile": 30.71, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.49, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 94.38, "10th_percentile": 94.38, "90th_percentile": 94.38, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.62, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INTERROGATION EVAL F2F 1/DUAL/MLT LEADS CVDFB", "code_information": [ { "code": "93289", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 279.69, "discounted_cash": 36.0, "minimum": 36.82, "maximum": 243.8897, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 145.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 176.21, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 140.97, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.27, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC TUBE THORACOSTOMY W DRAIN SYS", "code_information": [ { "code": "32551", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1889.69, "discounted_cash": 1553.0, "minimum": 566.907, "maximum": 1889.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1889.69, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1889.69, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1889.69, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1693.01, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1553.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1889.69, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC EEG,COMA/SLEEP RECORD ONLY", "code_information": [ { "code": "95822", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1484.69, "discounted_cash": 213.0, "minimum": 213.05, "maximum": 1294.6497, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 839.33, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1019.59, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 815.7, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 360.31, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PERQ RADIOFREQ ABLATE LIVER TUMOR =>1", "code_information": [ { "code": "47382", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 23721.9, "discounted_cash": 5965.0, "minimum": 5965.14, "maximum": 23721.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 23500.27, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 23721.9, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 22838.73, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6502.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5965.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10088.24, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PROTEIN E-PHORESIS, SERUM", "code_information": [ { "code": "84165", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 286.88, "discounted_cash": 10.0, "minimum": 10.4371, "maximum": 250.1594, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 154.22, "10th_percentile": 146.83, "90th_percentile": 183.6, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.05, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 10.44, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 146.19, "10th_percentile": 146.19, "90th_percentile": 146.19, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 154.38, "10th_percentile": 146.99, "90th_percentile": 157.35, "count": "24" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 56.35 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 48.01, "10th_percentile": 48.01, "90th_percentile": 48.01, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.71, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 200.12, "10th_percentile": 56.35, "90th_percentile": 201.96, "count": "17" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.16, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC", "code_information": [ { "code": "392", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6977.0, "minimum": 5400.71, "maximum": 20179.9892, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 18166.62, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 9122.63, "10th_percentile": 9122.63, "90th_percentile": 20978.54, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6737.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 14087.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6737.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "other", "standard_charge_dollar": 17171.5, "standard_charge_algorithm": "74.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 8710.7, "10th_percentile": 8710.7, "90th_percentile": 8710.7, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 17650.55, "standard_charge_algorithm": "76.27% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 7477.25, "10th_percentile": 7477.25, "90th_percentile": 23030.52, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6737.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 12781.15 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6977.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5400.71 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6977.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12781.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 20179.99, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 15526.86, "10th_percentile": 15526.86, "90th_percentile": 15526.86, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6737.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 6977.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6737.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8670.46 } ] } ] }, { "description": "PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE", "code_information": [ { "code": "175", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11494.0, "minimum": 9752.85, "maximum": 34748.0019, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 31281.17, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 16149.72, "10th_percentile": 16149.72, "90th_percentile": 16149.72, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11072.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 24820.73 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11072.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11072.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 20202.41 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 11494.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9752.85 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11494.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20202.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11072.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 11494.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11072.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15276.74 } ] } ] }, { "description": "HC PARVOVIRUS", "code_information": [ { "code": "86747", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 507.19, "discounted_cash": 15.0, "minimum": 14.6062, "maximum": 442.2697, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.03, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.26, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.61, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 78.87 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 15.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 15.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 15.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.42, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Magnesium Sulfate in Dextrose 5% IV Soln 1 GM/100ML", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "00338170940", "type": "NDC" }, { "code": "J3475", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0535, "maximum": 1.0535, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.05 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 72.46, "10th_percentile": 72.46, "90th_percentile": 144.91, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 80.49, "10th_percentile": 80.49, "90th_percentile": 80.49, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL C9363) SKIN SUB INTEGRA BILAYER PER SQ CM", "code_information": [ { "code": "C9363", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 126.52, "maximum": 605.4868, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 147.94 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITH CC", "code_information": [ { "code": "348", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11002.0, "minimum": 8713.26, "maximum": 24568.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10599.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 23649.81 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 10599.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 10599.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 24568.65 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 11002.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8713.26 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11002.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24568.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10599.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 11002.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10599.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14556.05 } ] } ] }, { "description": "HC (SUP SHELL L4396) STATIC OR DYNAMI AFO PRE CST", "code_information": [ { "code": "L4396", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 210.0, "minimum": 204.3501, "maximum": 355.6255, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 210.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 210.28, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 255.43, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 210.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 204.35, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 210.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 210.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 210.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 229.21, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 210.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 210.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 210.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 210.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 210.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 355.63, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Ceftazidime For Inj 1 GM", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "25021012720", "type": "NDC" }, { "code": "J0713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 3.44, "maximum": 3.44, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.44 } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA", "code_information": [ { "code": "894", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5739.0, "minimum": 4319.6, "maximum": 52203.1607, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5550.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 11147.28 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 5550.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 5550.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 10797.74 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 5739.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4319.6 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5739.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10797.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5550.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 5739.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 5550.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6860.96 } ] } ] }, { "description": "HC X-RAY TOE(S)", "code_information": [ { "code": "73660", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 370.0, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 370.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 223.4, "10th_percentile": 223.4, "90th_percentile": 223.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 370.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 177.04, "10th_percentile": 177.04, "90th_percentile": 177.04, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 225.76, "10th_percentile": 225.76, "90th_percentile": 225.76, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 201.83 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 258.11, "10th_percentile": 258.11, "90th_percentile": 258.11, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC TRLML BLLN ANGIOP OPEN/PERQ W/IMG S&I INIT VEIN", "code_information": [ { "code": "37248", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18979.4, "discounted_cash": 5615.0, "minimum": 5615.88, "maximum": 18979.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18979.4, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 18979.4, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 18979.4, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6121.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9497.58, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CCMCC", "code_information": [ { "code": "410", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13123.0, "minimum": 10735.67, "maximum": 47523.1629, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12634.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 28689.49 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12634.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12634.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 27458.05 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 13123.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10735.67 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13123.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 27458.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12634.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 13123.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12634.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17657.89 } ] } ] }, { "description": "NEUROLOGICAL EYE DISORDERS", "code_information": [ { "code": "123", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7121.0, "minimum": 5559.21, "maximum": 37875.395, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 6876.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 14430.57 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 6876.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 6876.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 14382.7 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "other", "standard_charge_dollar": 37788.52, "standard_charge_algorithm": "87% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 13943.11, "10th_percentile": 13943.11, "90th_percentile": 13943.11, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7121.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5559.21 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7121.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14382.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6876.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7121.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6876.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8881.77 } ] } ] }, { "description": "HC ASSAY OF CALCIUM, TOTAL", "code_information": [ { "code": "82310", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 36.25, "discounted_cash": 5.0, "minimum": 5.0145, "maximum": 31.61, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 23.2, "10th_percentile": 19.49, "90th_percentile": 23.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.27, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.01, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 18.47, "10th_percentile": 18.47, "90th_percentile": 36.94, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 19.88, "10th_percentile": 19.51, "90th_percentile": 19.88, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.08 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 23.07, "10th_percentile": 23.07, "90th_percentile": 23.07, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.62, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 25.52, "10th_percentile": 25.52, "90th_percentile": 25.52, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.73, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT TARSAL FX WO MANIP EA", "code_information": [ { "code": "28450", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 404.06, "discounted_cash": 243.0, "minimum": 121.218, "maximum": 404.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 404.06, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC STRAPPING ELBOW OR WRIST", "code_information": [ { "code": "29260", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 319.69, "discounted_cash": 58.0, "minimum": 58.2, "maximum": 278.7697, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 229.28, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 278.53, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 222.83, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 63.44, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 98.43, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "SKIN GRAFTS FOR INJURIES WITHOUT CCMCC", "code_information": [ { "code": "905", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12329.0, "minimum": 11407.74, "maximum": 32081.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11873.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 26804.8 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 11873.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 11873.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 32081.48 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12329.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11407.74 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12329.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32081.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11873.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 12329.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11873.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16497.9 } ] } ] }, { "description": "HC X-RAY THORACIC SPINE 2 VW", "code_information": [ { "code": "72070", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 608.44, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 530.5597, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 367.4, "10th_percentile": 367.4, "90th_percentile": 367.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 291.16, "10th_percentile": 291.16, "90th_percentile": 308.6, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 357.02, "10th_percentile": 357.02, "90th_percentile": 371.24, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 204.73 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 92.04, "10th_percentile": 92.04, "90th_percentile": 92.04, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 424.45, "10th_percentile": 424.45, "90th_percentile": 424.45, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC", "code_information": [ { "code": "058", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14049.0, "minimum": 12776.08, "maximum": 51748.1, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13523.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13523.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 51748.09 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14049.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12776.08 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14049.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 51748.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13523.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 14049.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13523.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19012.51 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13523.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 30890.39 } ] } ] }, { "description": "HC REMOVAL OF NAIL PLATE", "code_information": [ { "code": "11730", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 368.13, "discounted_cash": 197.0, "minimum": 110.439, "maximum": 368.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 368.13, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 368.13, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 368.13, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 215.79, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 334.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Lidocaine Inj 2% w/ Epinephrine-1:100000", "drug_information": { "unit": 20.0, "type": "ML" }, "code_information": [ { "code": "00409014701", "type": "NDC" }, { "code": "J2004", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 11.99, "10th_percentile": 11.99, "90th_percentile": 11.99, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 14.84, "10th_percentile": 14.84, "90th_percentile": 14.84, "count": "1 through 10" } ] } ] }, { "description": "HC CONTINUOUS INHALATION TX, 1ST HR", "code_information": [ { "code": "94644", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 525.31, "discounted_cash": 131.0, "minimum": 131.27, "maximum": 525.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 517.15, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 525.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 502.59, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.08, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 222.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC", "code_information": [ { "code": "651", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 29232.0, "minimum": 24034.32, "maximum": 322430.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 28092.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 66963.21 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 28092.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 28092.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 322429.95 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 29232.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24034.32 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 29232.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 322430.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 28092.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 29232.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 28092.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 41214.72 } ] } ] }, { "description": "HC (SUP SHELL Q4170) CYGNUS, PER SQ CM", "code_information": [ { "code": "Q4170", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 126.52, "maximum": 956.191, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 956.19 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MUMPS", "code_information": [ { "code": "86735", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 100.94, "discounted_cash": 13.0, "minimum": 12.682, "maximum": 88.0197, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 58.33, "10th_percentile": 58.33, "90th_percentile": 58.33, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.05, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.85, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 51.44, "10th_percentile": 51.44, "90th_percentile": 51.44, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 52.28, "10th_percentile": 52.28, "90th_percentile": 52.28, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 68.48 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 13.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 58.33, "10th_percentile": 58.33, "90th_percentile": 58.33, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.22, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 67.1, "10th_percentile": 67.1, "90th_percentile": 70.41, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.07, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CT UPPER EXTREMITY WO/W CONTRAST", "code_information": [ { "code": "73202", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2008.13, "discounted_cash": 173.0, "minimum": 173.07, "maximum": 1751.0894, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 681.83, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 828.26, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 662.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1743.35 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 292.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MAJOR CHEST TRAUMA WITH CC", "code_information": [ { "code": "184", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9140.0, "minimum": 7392.67, "maximum": 19228.1167, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8813.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 19228.12 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8813.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8813.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 16716.82 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9140.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7392.67 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9140.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16716.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 17429.31, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 7202.56, "10th_percentile": 7202.56, "90th_percentile": 7202.56, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8813.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 9140.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8813.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11834.58 } ] } ] }, { "description": "HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC", "code_information": [ { "code": "421", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14262.0, "minimum": 11334.37, "maximum": 49911.8857, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13727.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 31396.35 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13727.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13727.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 46896.7 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14262.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11334.37 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14262.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 46896.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13727.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 14262.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13727.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19323.92 } ] } ] }, { "description": "HC SPINAL PUNCTURE,LUMBAR,DIAGNOSTIC", "code_information": [ { "code": "62270", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 948.44, "discounted_cash": 696.0, "minimum": 284.532, "maximum": 948.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 948.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 948.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 948.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 719.85, "10th_percentile": 719.85, "90th_percentile": 719.85, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 759.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 948.44, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL C1726) CATHETER BALLOON DILAT NON-VASCULAR", "code_information": [ { "code": "C1726", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 829.82, "10th_percentile": 829.82, "90th_percentile": 1580.84, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 834.06, "10th_percentile": 764.11, "90th_percentile": 834.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 834.06, "10th_percentile": 834.06, "90th_percentile": 948.74, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL C1788) PORT INDWELLING", "code_information": [ { "code": "C1788", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1339.2, "10th_percentile": 1339.2, "90th_percentile": 1339.2, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1366.19, "10th_percentile": 1366.19, "90th_percentile": 1366.19, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 1373.17, "10th_percentile": 1195.13, "90th_percentile": 1373.17, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 1406.13, "10th_percentile": 1406.13, "90th_percentile": 1406.13, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 1373.17, "10th_percentile": 1371.92, "90th_percentile": 1473.12, "count": "1 through 10" } ] } ] }, { "description": "HC X-RAYS, BONE SURVEY, INFANT", "code_information": [ { "code": "77076", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 344.38, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 344.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 344.38, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 344.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 344.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 344.38 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REPR WND CPLX EYE/EAR/NOSE/LIP 2.6-7.5 CM", "code_information": [ { "code": "13152", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2362.81, "discounted_cash": 729.0, "minimum": 708.843, "maximum": 2362.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2362.81, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2362.81, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2362.81, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 794.87, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 729.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1233.29, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CRYOPRECIPITATE POOLED PRODUCT", "code_information": [ { "code": "P9012", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2342.19, "discounted_cash": 71.0, "minimum": 71.6, "maximum": 2042.3897, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 282.08, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 342.66, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 274.13, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 71.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 71.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 78.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 71.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 71.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 121.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC PROTEIN TOT XCPT REFRACTOMETRY URINE", "code_information": [ { "code": "84156", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 101.25, "discounted_cash": 3.0, "minimum": 3.5665, "maximum": 88.29, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 51.4, "10th_percentile": 43.18, "90th_percentile": 51.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.46, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3.57, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 31.85, "10th_percentile": 31.85, "90th_percentile": 51.6, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 34.28, "10th_percentile": 34.28, "90th_percentile": 55.53, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.26 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 16.4, "10th_percentile": 16.4, "90th_percentile": 16.4, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 70.63, "10th_percentile": 44.0, "90th_percentile": 71.28, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CCMCC", "code_information": [ { "code": "218", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 51055.0, "minimum": 41177.07, "maximum": 142202.03, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 49032.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 118814.62 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 49032.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 49032.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 142202.03 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 51055.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41177.07 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 51055.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 142202.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 49032.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 51055.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 49032.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 73128.38 } ] } ] }, { "description": "HC (SUP SHELL A4222) INFUSION SUPPLIES WITH PUMP", "code_information": [ { "code": "A4222", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 49.0, "minimum": 47.6862, "maximum": 82.9872, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 49.07, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 59.61, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 47.69, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 49.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 49.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 53.49, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 49.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 49.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 82.99, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L4386) NON-PNEUM WALK BOOT PRE CST", "code_information": [ { "code": "L4386", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 190.0, "minimum": 184.7975, "maximum": 321.5986, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 190.16, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 230.99, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 184.8, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 190.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 190.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 207.27, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 190.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 190.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 321.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L8610) OCULAR IMPLANT", "code_information": [ { "code": "L8610", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 716.0, "minimum": 696.3627, "maximum": 1211.8632, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 716.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 716.57, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 870.42, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 716.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 696.36, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 716.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 716.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 716.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 781.06, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 716.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 716.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 716.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 716.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 716.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1211.86, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS", "code_information": [ { "code": "065", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8731.0, "minimum": 7038.3, "maximum": 26324.3495, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 23697.95, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 11602.12, "10th_percentile": 11602.12, "90th_percentile": 17540.33, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8420.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 18255.96 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8420.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 23097.2, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 27073.81, "10th_percentile": 27073.81, "90th_percentile": 27073.81, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8420.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 23122.98 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "other", "standard_charge_dollar": 26263.97, "standard_charge_algorithm": "87% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 15756.33, "10th_percentile": 15756.33, "90th_percentile": 15756.33, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8731.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7038.3 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8731.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23123.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8420.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8731.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8420.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11236.23 } ] } ] }, { "description": "HC HEART/LUNG RESUSCITATION (CPR)", "code_information": [ { "code": "92950", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1464.38, "discounted_cash": 213.0, "minimum": 213.05, "maximum": 1276.9394, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 839.33, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1019.59, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 815.7, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 360.31, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6457) TUBULAR DRESSING - A6457 - RU272066", "code_information": [ { "code": "A6457", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 1.0, "minimum": 1.5743, "maximum": 2.7397, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.57, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.77, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2.74, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.62, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.97, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6448) LT COMPRES BAND <3/YD - A6448 - 27100024", "code_information": [ { "code": "A6448", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 1.0, "minimum": 1.5938, "maximum": 2.7736, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.64, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.99, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.59, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.79, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2.77, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF GLUCAGON", "code_information": [ { "code": "82943", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 246.88, "discounted_cash": 14.0, "minimum": 13.887, "maximum": 215.2794, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 63.88, "10th_percentile": 63.88, "90th_percentile": 63.88, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.36, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13.89, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 74.98 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.58, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.17, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH CC", "code_information": [ { "code": "424", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17687.0, "minimum": 15803.47, "maximum": 48032.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17014.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 39535.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 17014.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 17014.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 48032.59 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 17687.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15803.47 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17687.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 48032.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17014.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 17687.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17014.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24333.12 } ] } ] }, { "description": "HC ARC BLOOD TYPING, RH (D)", "code_information": [ { "code": "86901", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 57.81, "discounted_cash": 36.0, "minimum": 15.6891, "maximum": 57.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 31.08, "10th_percentile": 31.08, "90th_percentile": 37.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 57.81, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 57.81, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 57.81, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.69 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 13.37, "10th_percentile": 13.37, "90th_percentile": 13.37, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 57.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Magnesium Sulfate IV Soln 20 GM/500ML (40 MG/ML)", "drug_information": { "unit": 500.0, "type": "ML" }, "code_information": [ { "code": "00409205001", "type": "NDC" }, { "code": "J3475", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0535, "maximum": 1.0535, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.05 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 72.46, "10th_percentile": 72.46, "90th_percentile": 144.91, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 80.49, "10th_percentile": 80.49, "90th_percentile": 80.49, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL A6449) LT COMPRES BAND >=3 <5/YD - A6449 - 27090039", "code_information": [ { "code": "A6449", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 2.0, "minimum": 2.4295, "maximum": 4.228, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.04, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2.43, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Fentanyl Citrate Preservative Free (PF) Inj 100 MCG/2ML", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "00409909412", "type": "NDC" }, { "code": "J3010", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.806, "maximum": 1.806, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 11.99, "10th_percentile": 11.99, "90th_percentile": 28.54, "count": "52" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.81 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 14.84, "10th_percentile": 4.45, "90th_percentile": 29.69, "count": "19" } ] } ] }, { "description": "HC (SUP SHELL Q4134) HMATRIX", "code_information": [ { "code": "Q4134", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 126.52, "maximum": 605.4868, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 348.47 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC TUMOR IMAGING, LIMITED AREA", "code_information": [ { "code": "78800", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1966.25, "discounted_cash": 394.0, "minimum": 394.45, "maximum": 1887.7194, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1553.98, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1887.72, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1510.23, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1772.61 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF FETAL FIBRONECTIN", "code_information": [ { "code": "82731", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1165.0, "discounted_cash": 64.0, "minimum": 62.5936, "maximum": 1015.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 78.24, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 62.59, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 337.97 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 70.21, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 337.97, "10th_percentile": 337.97, "90th_percentile": 337.97, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 108.93, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC THERAPEUTIC SPINAL PNXR DRAINAGE CSF W/FLUOR/CT", "code_information": [ { "code": "62329", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3506.56, "discounted_cash": 696.0, "minimum": 696.49, "maximum": 3333.1922, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2743.89, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3333.19, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2666.65, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 759.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1177.9, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC SEC ABDOMINAL WALL SUTURE EVISCERATION/DEHSN", "code_information": [ { "code": "49900", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 34281.6, "minimum": 10284.48, "maximum": 29893.5552, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 16804.48 } ] } ] }, { "description": "HC X-RAY EXAM SELLA", "code_information": [ { "code": "70240", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 526.56, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 459.1603, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 410.95, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 210.61 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" } ] } ] }, { "description": "HC QUANTITATIVE ASSAY, DRUG", "code_information": [ { "code": "80299", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 380.31, "discounted_cash": 18.0, "minimum": 18.1144, "maximum": 331.6303, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 192.86, "10th_percentile": 192.86, "90th_percentile": 192.86, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.64, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 18.11, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 167.25, "10th_percentile": 167.25, "90th_percentile": 173.97, "count": "17" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 97.81 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 265.3, "10th_percentile": 265.3, "90th_percentile": 265.3, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.52, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC SMEAR, FLUOR STAIN, W INTERP", "code_information": [ { "code": "87206", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 129.38, "discounted_cash": 5.0, "minimum": 5.238, "maximum": 112.8194, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.55, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.24, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.28 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.12, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC NM BONE IMAGING, 3 PHASE", "code_information": [ { "code": "78315", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1769.06, "discounted_cash": 394.0, "minimum": 394.45, "maximum": 1769.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1553.98, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1769.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1510.23, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1769.06 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC NUCLEAR THERAPY, MONOCLONAL AB", "code_information": [ { "code": "79403", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3777.81, "discounted_cash": 230.0, "minimum": 230.23, "maximum": 3294.2503, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 907.01, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1101.81, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 881.48, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 886.3 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 250.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 230.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 389.36, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CANDIDA DNA DIR PROBE", "code_information": [ { "code": "87480", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 81.88, "discounted_cash": 20.0, "minimum": 19.4846, "maximum": 81.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 49.4, "10th_percentile": 41.5, "90th_percentile": 49.4, "count": "34" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.35, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 19.48, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 41.72, "10th_percentile": 41.72, "90th_percentile": 41.72, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 42.34, "10th_percentile": 42.34, "90th_percentile": 44.06, "count": "28" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 81.88 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 65.5, "10th_percentile": 49.4, "90th_percentile": 65.5, "count": "18" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.85, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 57.11, "10th_percentile": 57.11, "90th_percentile": 57.11, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.91, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC HEPATITIS C VIRUS, GENOTYPE ANAL DNA/RNA", "code_information": [ { "code": "87902", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3254.06, "discounted_cash": 257.0, "minimum": 250.1899, "maximum": 2837.5403, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1150.8, "10th_percentile": 1150.8, "90th_percentile": 1150.8, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 312.72, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 250.19, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 1683.83, "10th_percentile": 1683.83, "90th_percentile": 1683.83, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1350.89 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 280.62, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 2270.03, "10th_percentile": 2270.03, "90th_percentile": 2270.03, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 435.4, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "COMPLICATIONS OF TREATMENT WITH MCC", "code_information": [ { "code": "919", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14972.0, "minimum": 12621.74, "maximum": 36864.3399, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14408.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 33082.26 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14408.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14408.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 28328.96 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14972.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12621.74 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14972.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 28329.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14408.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 14972.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14408.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20361.57 } ] } ] }, { "description": "HC MRI JOINT OF LEG W/CONTRAST", "code_information": [ { "code": "73722", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3321.88, "discounted_cash": 773.0, "minimum": 773.49, "maximum": 3321.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3047.24, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3321.88, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2961.46, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2164.58 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 843.1, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 773.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1308.13, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Dopamine in Dextrose 5% Inj 3.2 MG/ML", "drug_information": { "unit": 250.0, "type": "ML" }, "code_information": [ { "code": "00338100902", "type": "NDC" }, { "code": "J1265", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.5265, "maximum": 1.5265, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.53 } ] } ] }, { "description": "HC INJECTION SINUS TRACT THERAPEUTIC SEPARATE PROC", "code_information": [ { "code": "20500", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2700.94, "discounted_cash": 1530.0, "minimum": 810.282, "maximum": 2700.94, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2589.14, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2700.94, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2700.94, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2700.94, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1668.74, "additional_payer_notes": "109.00% of Medicare Rates" } ] } ] }, { "description": "MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH CC", "code_information": [ { "code": "755", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9321.0, "minimum": 7683.37, "maximum": 94632.3612, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8986.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 19656.37 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8986.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8986.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 18020.26 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9321.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7683.37 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9321.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18020.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8986.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 9321.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8986.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12098.16 } ] } ] }, { "description": "CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC", "code_information": [ { "code": "236", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 32905.0, "minimum": 28461.2, "maximum": 102029.7116, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "other", "standard_charge_dollar": 91850.14, "standard_charge_algorithm": "78.5% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 28478.34, "10th_percentile": 28478.34, "90th_percentile": 28478.34, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 31616.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 75690.95 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 31616.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 31616.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 91338.49 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 32905.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28461.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 32905.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 91338.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 31616.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 32905.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 31616.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 46586.49 } ] } ] }, { "description": "HC CT SCAN LUMBAR SPINE WO/W CONTRAST", "code_information": [ { "code": "72133", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2535.94, "discounted_cash": 173.0, "minimum": 173.07, "maximum": 2211.3397, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 681.83, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 828.26, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 662.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1260.7 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.65, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 292.7, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "816", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5854.0, "minimum": 4563.93, "maximum": 19715.1003, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5660.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 11420.14 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 5660.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 5660.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 10392.48 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 5854.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4563.93 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5854.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10392.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5660.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 5854.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 5660.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7028.9 } ] } ] }, { "description": "HC (SUP SHELL L2106) AFO TIB FX CAST PLASTER MOLD", "code_information": [ { "code": "L2106", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 1041.0, "minimum": 1012.3727, "maximum": 1761.8076, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1041.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1041.75, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1265.41, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1041.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1012.37, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1041.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1041.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1041.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1135.51, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1041.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1041.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1041.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1041.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1041.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1761.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Lidocaine Inj 1% w/ Epinephrine-1:100000", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "00409317818", "type": "NDC" }, { "code": "J2004", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 11.99, "10th_percentile": 11.99, "90th_percentile": 11.99, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 14.84, "10th_percentile": 14.84, "90th_percentile": 14.84, "count": "1 through 10" } ] } ] }, { "description": "MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "830", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12494.0, "minimum": 10122.45, "maximum": 41690.73, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12031.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 27195.11 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 12031.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 12031.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 41690.73 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 12494.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10122.45 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12494.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 41690.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12031.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 12494.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12031.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16738.13 } ] } ] }, { "description": "HC ANTIEPILEPTICS NOT OTHERWISE SPECIFIED 1-3 - G0480 - 30100444", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 874.38, "discounted_cash": 114.0, "minimum": 34.218, "maximum": 1015.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 254.02, "10th_percentile": 72.91, "90th_percentile": 807.41, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 139.0, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 111.2, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 156.38, "10th_percentile": 156.38, "90th_percentile": 171.03, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 823.75, "10th_percentile": 177.26, "90th_percentile": 856.52, "count": "28" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 600.44 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 206.85, "10th_percentile": 206.85, "90th_percentile": 470.25, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 124.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 229.77, "10th_percentile": 218.68, "90th_percentile": 917.78, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 193.52, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ORBITAL IMPLANT REMOVAL/REVISION", "code_information": [ { "code": "67560", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13121.3, "discounted_cash": 3879.0, "minimum": 3879.12, "maximum": 13121.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3879.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13121.3, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 13121.3, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3879.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13121.3, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3879.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3879.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3879.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4228.24, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3879.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3879.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3879.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3879.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3879.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6560.37, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY THYROID STIM HORMONE", "code_information": [ { "code": "84443", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 264.38, "discounted_cash": 16.0, "minimum": 16.3262, "maximum": 230.5394, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 169.2, "10th_percentile": 142.13, "90th_percentile": 169.2, "count": "176" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.41, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 16.33, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 134.73, "10th_percentile": 134.73, "90th_percentile": 161.37, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 145.0, "10th_percentile": 142.28, "90th_percentile": 145.0, "count": "281" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 88.15 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 75.1, "10th_percentile": 75.1, "90th_percentile": 169.2, "count": "80" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 184.43, "10th_percentile": 88.15, "90th_percentile": 186.12, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.41, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL Q4238) DERM-MAXX, PER SQ CM", "code_information": [ { "code": "Q4238", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 126.52, "maximum": 3536.7285, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3536.73 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY HAND 3+ VW", "code_information": [ { "code": "73130", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 513.44, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 447.7197, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 260.4, "10th_percentile": 114.3, "90th_percentile": 310.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 410.95, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 260.42, "10th_percentile": 260.42, "90th_percentile": 260.42, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 313.28, "10th_percentile": 301.24, "90th_percentile": 313.28, "count": "11" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 254.46 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 114.48, "10th_percentile": 114.48, "90th_percentile": 310.0, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 341.0, "10th_percentile": 314.88, "90th_percentile": 358.17, "count": "17" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC", "code_information": [ { "code": "736", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 28233.0, "minimum": 27133.8, "maximum": 69865.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 27133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 64590.64 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 27133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 27133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 69865.76 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 28233.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27253.43 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 28233.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 69865.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 27133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 28233.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 27133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 39754.45 } ] } ] }, { "description": "HC LEUKOCYTE (WBC) COUNT", "code_information": [ { "code": "85048", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 72.5, "discounted_cash": 2.0, "minimum": 2.4684, "maximum": 63.22, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2.54, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.09, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2.47, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.33 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.77, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 48.18, "10th_percentile": 48.18, "90th_percentile": 50.58, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.3, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4402) LUBRICANT PER OUNCE", "code_information": [ { "code": "A4402", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 2.0, "minimum": 2.206, "maximum": 3.839, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2.27, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2.76, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2.21, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.47, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3.84, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Nalbuphine HCl Inj 10 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00409146371", "type": "NDC" }, { "code": "J2300", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 6.622, "maximum": 6.622, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.62 } ] } ] }, { "description": "CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC", "code_information": [ { "code": "258", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24944.0, "minimum": 19417.79, "maximum": 67952.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 23978.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 56777.24 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 23978.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 23978.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 67952.48 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 24944.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19417.79 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24944.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 67952.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 23978.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 24944.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 23978.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34945.43 } ] } ] }, { "description": "HC ASSAY OF PREGNENOLONE", "code_information": [ { "code": "84140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 106.88, "discounted_cash": 20.0, "minimum": 20.0871, "maximum": 106.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 85.5, "10th_percentile": 85.5, "90th_percentile": 85.5, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.11, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 20.09, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 106.88 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.53, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.96, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC NEG PRESS WOUND TX W DME, 16 <=48 SQ IN - A6197 - 27200112", "code_information": [ { "code": "A6197", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 23.0, "minimum": 22.779, "maximum": 39.6417, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 23.44, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 28.47, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 22.78, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 23.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 23.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 23.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 23.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39.64, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REMOVAL TUNNELED INTRAPERITONEAL CATHETER", "code_information": [ { "code": "49422", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11803.1, "discounted_cash": 3115.0, "minimum": 3115.49, "maximum": 11803.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11803.1, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 11803.1, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11803.1, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3395.88, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3115.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5268.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "SPLENIC PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "801", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15565.0, "minimum": 11362.75, "maximum": 41283.52, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14978.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 34493.52 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14978.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14978.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 41283.52 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 15565.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11362.75 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15565.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 41283.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14978.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 15565.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14978.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21230.17 } ] } ] }, { "description": "HC SCREENING DIGITAL BREAST TOMOSYNTHESIS BILAT", "code_information": [ { "code": "77063", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 593.13, "discounted_cash": 21.0, "minimum": 20.9034, "maximum": 517.2094, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 379.6, "10th_percentile": 379.6, "90th_percentile": 379.6, "count": "173" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 21.51, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 26.13, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medigap", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.59, "median_amount": 24.9, "10th_percentile": 24.9, "90th_percentile": 24.9, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 20.9, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 300.83, "10th_percentile": 300.83, "90th_percentile": 417.56, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 368.88, "10th_percentile": 361.9, "90th_percentile": 368.88, "count": "267" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.71 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 21.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 95.03, "10th_percentile": 95.03, "90th_percentile": 379.6, "count": "79" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 21.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.45, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 38.71, "10th_percentile": 38.71, "90th_percentile": 417.56, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 21.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.38, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF TESTOSTERONE", "code_information": [ { "code": "84402", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 447.19, "discounted_cash": 25.0, "minimum": 24.7517, "maximum": 389.9497, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 30.94, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 24.75, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 133.65 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.76, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.07, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT SHLDR DISLOC,PROX HUM FX W MANIP", "code_information": [ { "code": "23675", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 852.81, "discounted_cash": 1586.0, "minimum": 255.843, "maximum": 852.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 852.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 852.81, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 852.81, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 852.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 852.81, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 852.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 852.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 852.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 852.81, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 852.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 852.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 852.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 852.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 852.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 852.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "856", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 35642.0, "minimum": 31226.27, "maximum": 92587.1881, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 34243.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 82194.28 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 34243.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 34243.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 65460.56 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 35642.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31226.27 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 35642.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 65460.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 34243.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 35642.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 34243.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 50589.19 } ] } ] }, { "description": "HC REMOVAL FOREIGN BODY DEEP THIGH/KNEE", "code_information": [ { "code": "27372", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8870.63, "discounted_cash": 2866.0, "minimum": 2661.189, "maximum": 8870.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8870.63, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8870.63, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8870.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3124.04, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2866.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4847.13, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CCMCC", "code_information": [ { "code": "084", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8317.0, "minimum": 6617.48, "maximum": 21746.651, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8023.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 17271.15 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8023.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8023.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 19588.67 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 8317.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6617.48 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8317.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19588.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8023.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 8317.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8023.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10630.1 } ] } ] }, { "description": "Acetylcysteine Inj 200 MG/ML", "drug_information": { "unit": 30.0, "type": "ML" }, "code_information": [ { "code": "63323096321", "type": "NDC" }, { "code": "J0132", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC CLSD TREAT TRIMALLEOLAR FX WO MANIP", "code_information": [ { "code": "27816", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 494.38, "discounted_cash": 243.0, "minimum": 148.314, "maximum": 494.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 494.38, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 494.38, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 494.38, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 411.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "KCl 20 MEQ/L (0.15%) in NaCl 0.45% Inj", "drug_information": { "unit": 1000.0, "type": "ML" }, "code_information": [ { "code": "00338070434", "type": "NDC" }, { "code": "J3480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 58.52, "10th_percentile": 58.52, "90th_percentile": 58.52, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC ANTIHUMAN GLOBULIN INDIR QUAL EA REAGENT CELL", "code_information": [ { "code": "86885", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 34.06, "discounted_cash": 168.0, "minimum": 10.218, "maximum": 34.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 34.06, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 34.06, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 34.06, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.01 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 34.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 34.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.06, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 34.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 34.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.06, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC US INFT HIPS R-T IMG LMTD STATIC PHYS/QHP MANJ", "code_information": [ { "code": "76886", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 510.94, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 510.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 308.4, "10th_percentile": 308.4, "90th_percentile": 308.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 410.95, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 299.69, "10th_percentile": 299.69, "90th_percentile": 299.69, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 510.94 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 275.53, "10th_percentile": 275.53, "90th_percentile": 275.53, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 339.24, "10th_percentile": 339.24, "90th_percentile": 356.43, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC TEMPOROMANDBLE JT ARTHROGRAPHY RS&I", "code_information": [ { "code": "70332", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1396.25, "discounted_cash": 235.0, "minimum": 235.42, "maximum": 1217.53, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 901.35, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 503.12 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 256.61, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 398.14, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 927.46, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1126.65, "additional_payer_notes": "478.57% of Medicare Rates" } ] } ] }, { "description": "HC CANNABINOIDS NATURAL ASSAY - 80349 - 30100418", "code_information": [ { "code": "80349", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 429.69, "minimum": 70.4174, "maximum": 374.6897, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70.42 } ] } ] }, { "description": "HC STREP A ASSAY W/OPTIC", "code_information": [ { "code": "87880", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 127.5, "discounted_cash": 16.0, "minimum": 16.0639, "maximum": 111.18, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 77.0, "10th_percentile": 64.68, "90th_percentile": 77.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.53, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.08, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 65.99, "10th_percentile": 65.99, "90th_percentile": 65.99, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 86.74 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 16.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 73.89, "10th_percentile": 73.89, "90th_percentile": 73.89, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.02, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 84.7, "10th_percentile": 84.7, "90th_percentile": 88.94, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 16.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.96, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC BETA-2 PROTEIN", "code_information": [ { "code": "82232", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 267.19, "discounted_cash": 16.0, "minimum": 15.7237, "maximum": 232.9897, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 143.64, "10th_percentile": 143.64, "90th_percentile": 171.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.65, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 15.72, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 84.9 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.64, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.36, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CATHETERIZE FOR URINE SPEC", "code_information": [ { "code": "P9612", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14.38, "discounted_cash": 9.0, "minimum": 4.314, "maximum": 14.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.35, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9.08, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.38, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L0140) CERVICAL SEMI-RIGID ADJUSTAB", "code_information": [ { "code": "L0140", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 95.0, "minimum": 92.4182, "maximum": 160.8331, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 95.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 95.1, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 115.52, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 95.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 92.42, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 95.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 95.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 95.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 103.66, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 95.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 95.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 95.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 95.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 95.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 160.83, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Dextrose 5% w/ Sodium Chloride 0.9%", "drug_information": { "unit": 500.0, "type": "ML" }, "code_information": [ { "code": "00338008903", "type": "NDC" }, { "code": "J7042", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2.6875, "maximum": 2.6875, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2.69 } ] } ] }, { "description": "OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC", "code_information": [ { "code": "205", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14973.0, "minimum": 13066.09, "maximum": 36046.5836, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14410.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 33085.88 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 14410.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 14410.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 20656.37 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 14973.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13066.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14973.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20656.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14410.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 14973.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14410.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20363.8 } ] } ] }, { "description": "HC IMMUNFIX E-PHORSIS/URINE/CSF", "code_information": [ { "code": "86335", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 272.19, "discounted_cash": 29.0, "minimum": 28.5223, "maximum": 237.3497, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 29.35, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 35.65, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 28.52, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 154.01 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 29.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 29.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.99, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 29.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 49.64, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MRI, LUMBAR SPINE COMBO", "code_information": [ { "code": "72158", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3257.5, "discounted_cash": 344.0, "minimum": 344.22, "maximum": 2840.54, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1751.23, "10th_percentile": 1751.23, "90th_percentile": 1751.23, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1356.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1647.33, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1317.92, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1987.6, "10th_percentile": 1987.6, "90th_percentile": 2025.9, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1939.3 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 2272.43, "10th_percentile": 2272.43, "90th_percentile": 2272.43, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CANALITH REPOSITIONING PER DAY", "code_information": [ { "code": "95992", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 170.94, "discounted_cash": 29.0, "minimum": 28.2794, "maximum": 149.0597, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 29.1, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 35.35, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 28.28, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 29.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 108.31, "10th_percentile": 108.31, "90th_percentile": 108.31, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 29.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.72, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 29.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 49.21, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT", "code_information": [ { "code": "933", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 30664.0, "minimum": 29466.9, "maximum": 84219.24, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 29466.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 70367.57 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 29466.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 29466.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 84219.24 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 30664.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29947.9 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 30664.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 84219.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 29466.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 30664.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 29466.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 43310.05 } ] } ] }, { "description": "HC (SUP SHELL A6234) HYDROCOLLD DRG <=16 W/O BDR - A6234 - 27200131", "code_information": [ { "code": "A6234", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 9.0, "minimum": 9.0669, "maximum": 15.7789, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.33, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.33, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9.07, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 9.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 9.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 9.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC NM BRAIN IMAGING < 4 STATIC VIEWS", "code_information": [ { "code": "78600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1752.19, "discounted_cash": 394.0, "minimum": 394.45, "maximum": 1752.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1553.98, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1752.19, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1510.23, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1298.75 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL Q4150) ALLOWRAP DS OR DRY 1 SQ CM", "code_information": [ { "code": "Q4150", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 126.52, "maximum": 605.4868, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 177.93 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC OT THR ACTIVITY OTA COMPLEX EA 1 ", "code_information": [ { "code": "97530", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 209.38, "discounted_cash": 33.0, "minimum": 32.3998, "maximum": 182.5794, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 217.73, "10th_percentile": 217.73, "90th_percentile": 217.73, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 33.34, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 40.5, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 32.4, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 33.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 33.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.34, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 33.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 33.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 56.38, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF LITHIUM", "code_information": [ { "code": "80178", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 133.13, "discounted_cash": 6.0, "minimum": 6.4236, "maximum": 116.0894, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 80.4, "10th_percentile": 80.4, "90th_percentile": 80.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.03, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6.42, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 67.84, "10th_percentile": 67.84, "90th_percentile": 67.84, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 68.9, "10th_percentile": 68.9, "90th_percentile": 68.9, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.68 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 29.55, "10th_percentile": 29.55, "90th_percentile": 29.55, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 34.68, "10th_percentile": 34.68, "90th_percentile": 34.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.18, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC B CELLS, TOTAL COUNT", "code_information": [ { "code": "86355", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 238.75, "discounted_cash": 37.0, "minimum": 36.666, "maximum": 208.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 45.83, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 36.67, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 197.98 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 166.55, "10th_percentile": 166.55, "90th_percentile": 166.55, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 63.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC INSJ PERQ VAD W/RS&I R HEART VENOUS ACCESS ONLY", "code_information": [ { "code": "33995", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2071.56, "minimum": 621.468, "maximum": 2071.56, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 2071.56 } ] } ] }, { "description": "HC REVSC EVASC IVT ANGIOP UNI SF LES 1ST VSL", "code_information": [ { "code": "37254", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 27547.8, "discounted_cash": 5615.0, "minimum": 5615.88, "maximum": 26875.9169, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 22124.32, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 26875.92, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 21501.52, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6121.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5615.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9497.58, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REMOVE NASAL FB", "code_information": [ { "code": "30300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 322.19, "discounted_cash": 131.0, "minimum": 96.657, "maximum": 322.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 322.19, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 322.19, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 322.19, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.08, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 222.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CSF FLUID SCAN CISTERNOGRAPHY", "code_information": [ { "code": "78630", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1283.75, "discounted_cash": 535.0, "minimum": 385.125, "maximum": 1283.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1283.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1283.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1283.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1283.75 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 583.96, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 906.04, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF PERSONALITY AND IMPULSE CONTROL", "code_information": [ { "code": "883", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16002.0, "minimum": 12831.45, "maximum": 35530.7264, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15397.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 35530.73 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 15397.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 15397.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 21700.69 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 16002.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12831.45 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16002.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21700.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15397.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 16002.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15397.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21868.56 } ] } ] }, { "description": "HC GIARDIA AG EIA", "code_information": [ { "code": "87329", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 165.94, "discounted_cash": 11.0, "minimum": 11.6422, "maximum": 144.6997, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.55, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.64, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 62.86 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 53.55, "10th_percentile": 53.55, "90th_percentile": 53.55, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.06, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.26, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC NUCLEAR ANTIGEN ANTIBODY", "code_information": [ { "code": "86235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 185.63, "discounted_cash": 17.0, "minimum": 17.4244, "maximum": 161.8694, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 278.04, "10th_percentile": 112.0, "90th_percentile": 736.18, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.78, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 17.42, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 267.54, "10th_percentile": 189.19, "90th_percentile": 267.54, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 287.95, "10th_percentile": 175.17, "90th_percentile": 299.69, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 94.08 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.54, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 369.6, "10th_percentile": 224.84, "90th_percentile": 641.36, "count": "19" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.32, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF TRIGLYCERIDES", "code_information": [ { "code": "84478", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 154.69, "discounted_cash": 5.0, "minimum": 5.5781, "maximum": 134.8897, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 83.16, "10th_percentile": 83.16, "90th_percentile": 99.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.97, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.58, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 78.83, "10th_percentile": 78.83, "90th_percentile": 78.83, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 83.25, "10th_percentile": 83.25, "90th_percentile": 84.84, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.12 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 108.9, "10th_percentile": 108.9, "90th_percentile": 108.9, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4349) DISPOSABLE MALE EXTERNAL CAT", "code_information": [ { "code": "A4349", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 2.0, "minimum": 2.7891, "maximum": 4.8537, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2.87, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.49, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2.79, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.13, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.85, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "Meropenem IV For Soln 500 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "55150020720", "type": "NDC" }, { "code": "J2185", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC", "code_information": [ { "code": "650", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 36803.0, "minimum": 31888.64, "maximum": 84953.5458, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 35357.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 84953.55 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 35357.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 35357.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 43344.87 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 36803.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31888.64 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 36803.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 43344.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 35357.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 36803.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 35357.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 52287.47 } ] } ] }, { "description": "HC INS INTRVAS VC FILTR W/WO VAS ACS VSL SELXN S&I", "code_information": [ { "code": "37619", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15691.9, "discounted_cash": 5490.0, "minimum": 4707.57, "maximum": 15691.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15691.9, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15691.9, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 15691.9, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5984.62, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5490.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9285.5, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC NM HEPATOBIL SYST IMAG INC GB W/PHARMA INTERVENJ", "code_information": [ { "code": "78227", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1631.25, "discounted_cash": 535.0, "minimum": 489.375, "maximum": 1631.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 876.96, "10th_percentile": 876.96, "90th_percentile": 876.96, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1631.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1631.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1631.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1631.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 625.15, "10th_percentile": 625.15, "90th_percentile": 625.15, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 583.96, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 535.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 906.04, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DSTRJ LESION PALATE/UVULA THERMAL CRYO/CHEM", "code_information": [ { "code": "42160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12218.4, "discounted_cash": 3271.0, "minimum": 3271.37, "maximum": 12218.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12218.4, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 12218.4, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12218.4, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3565.79, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3271.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5532.54, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC LEFT HEART CATH INJ VETRICULOGRAPHY, RS/I", "code_information": [ { "code": "93452", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16181.9, "discounted_cash": 3198.0, "minimum": 3198.82, "maximum": 15308.5929, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12602.07, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15308.59, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12247.32, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3486.71, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5409.84, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF PHENYTOIN, TOTAL", "code_information": [ { "code": "80185", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 199.69, "discounted_cash": 13.0, "minimum": 12.8764, "maximum": 174.1297, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.09, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 69.53 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 59.23, "10th_percentile": 59.23, "90th_percentile": 59.23, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.44, "additional_payer_notes": "109.00% of Medicare Rates" } ] } ] }, { "description": "HC QUANT DIFFERENTIAL PULM PERFUSION W/WO IMAGING", "code_information": [ { "code": "78597", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 891.56, "discounted_cash": 394.0, "minimum": 267.468, "maximum": 891.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 891.56, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 891.56, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 891.56, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 891.56 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 429.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 394.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 667.09, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6450) LT COMPRES BAND >=5/YD - A6450 - 27100026", "code_information": [ { "code": "A6450", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 2.0, "minimum": 2.4295, "maximum": 4.228, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.04, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2.43, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REMOVAL OF SKIN TAGS, UP TO 15", "code_information": [ { "code": "11200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 233.44, "discounted_cash": 197.0, "minimum": 70.032, "maximum": 233.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 233.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 233.44, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 233.44, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 215.79, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 233.44, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4357) BEDSIDE DRAINAGE BAG", "code_information": [ { "code": "A4357", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 11.0, "minimum": 11.4284, "maximum": 19.8885, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.76, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.28, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.82, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.89, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC FUNGUS ISOLATION CULTURE", "code_information": [ { "code": "87102", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 210.94, "discounted_cash": 8.0, "minimum": 8.1728, "maximum": 183.9397, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 37.59, "10th_percentile": 37.59, "90th_percentile": 37.59, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.41, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.22, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 73.89, "10th_percentile": 73.89, "90th_percentile": 107.49, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 75.07, "10th_percentile": 75.07, "90th_percentile": 113.52, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.13 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 8.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 37.59, "10th_percentile": 37.59, "90th_percentile": 37.59, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.17, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 8.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6456) ZINC PASTE BAND W >=3<5/YD - A6456 - 27100099", "code_information": [ { "code": "A6456", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 1.0, "minimum": 1.7395, "maximum": 3.0272, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.79, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2.17, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.74, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.95, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3.03, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC BONE BX TR/NDL; SUPERF", "code_information": [ { "code": "20220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4501.25, "discounted_cash": 1629.0, "minimum": 1350.375, "maximum": 4501.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1016.38, "10th_percentile": 1016.38, "90th_percentile": 1016.38, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4501.25, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4501.25, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4501.25, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1776.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2756.05, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A5120) SKIN BARRIER, WIPE OR SWAB", "code_information": [ { "code": "A5120", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC", "code_information": [ { "code": "579", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 25678.0, "minimum": 22559.38, "maximum": 97806.184, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24681.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 58519.18 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 24681.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24681.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 38906.53 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 25678.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22559.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 25678.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 38906.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24681.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 25678.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 24681.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 36017.56 } ] } ] }, { "description": "HC CYTOMEG, DNA, AMP PROBE", "code_information": [ { "code": "87496", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 491.25, "discounted_cash": 35.0, "minimum": 34.1005, "maximum": 428.37, "payers_information": [ { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 59.34, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 42.62, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 34.1, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 180.79, "10th_percentile": 180.79, "90th_percentile": 180.79, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 184.12 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.25, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 184.12, "10th_percentile": 184.12, "90th_percentile": 184.12, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4407) EXT WEAR OST SKN BARR <=4SQ", "code_information": [ { "code": "A4407", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 12.0, "minimum": 12.1281, "maximum": 21.1062, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.48, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.16, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.13, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 12.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 12.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.11, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CYTOPATH SMEAR OTHER SOURCE", "code_information": [ { "code": "88162", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 244.69, "discounted_cash": 51.0, "minimum": 51.42, "maximum": 244.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 202.57, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 244.69, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 196.87, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 244.69 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.05, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC RADIOPHARMACEUTICAL QUANTIFICATION MEAS 1 AREA", "code_information": [ { "code": "78835", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1122.19, "minimum": 336.657, "maximum": 978.5497, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 599.61 } ] } ] }, { "description": "HC ENDOVAS PLCMNT ILIAC ARTERY OCCLSN DVC", "code_information": [ { "code": "34808", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13209.4, "minimum": 2944.0066, "maximum": 11518.5968, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 2944.01 } ] } ] }, { "description": "HC EPSTEIN-BARR ANTIBODY,NUCLEAR", "code_information": [ { "code": "86664", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 225.63, "discounted_cash": 15.0, "minimum": 14.8588, "maximum": 196.7494, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 136.2, "10th_percentile": 136.2, "90th_percentile": 136.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.29, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.57, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.86, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 114.98, "10th_percentile": 114.98, "90th_percentile": 114.98, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 80.23 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 15.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 68.35, "10th_percentile": 68.35, "90th_percentile": 68.35, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 15.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 149.82, "10th_percentile": 80.23, "90th_percentile": 157.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 15.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.86, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC BILIARY ENDOSCOPY PERCUT,DIL+STENT", "code_information": [ { "code": "47556", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2937.81, "discounted_cash": 10488.0, "minimum": 881.343, "maximum": 2937.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2937.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2937.81, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2937.81, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2937.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2937.81, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2937.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2937.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2937.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2937.81, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2937.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2937.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2937.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2937.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2937.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2937.81, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "SEPTIC ARTHRITIS WITH MCC", "code_information": [ { "code": "548", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15733.0, "minimum": 13943.71, "maximum": 41758.92, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15139.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 34891.05 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 15139.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 15139.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 41758.92 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 15733.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13943.71 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15733.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 41758.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15139.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 15733.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15139.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21474.85 } ] } ] }, { "description": "HC OFFICE/OUTPATIENT ESTABLISHED MINIMAL PROBLEM(S) - 99211 - 76100006", "code_information": [ { "code": "99211", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 137.5, "minimum": 41.25, "maximum": 119.9, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 96.8, "10th_percentile": 96.8, "90th_percentile": 96.8, "count": "1 through 10" } ] } ] }, { "description": "HC HERPES SIMPLEX TEST, TYPE 1", "code_information": [ { "code": "86695", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 254.06, "discounted_cash": 13.0, "minimum": 12.818, "maximum": 221.5403, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 153.4, "10th_percentile": 153.4, "90th_percentile": 153.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.02, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.82, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 69.21 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.38, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 178.86, "10th_percentile": 178.86, "90th_percentile": 178.86, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.31, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "FEVER AND INFLAMMATORY CONDITIONS", "code_information": [ { "code": "864", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7799.0, "minimum": 6215.35, "maximum": 18364.3287, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7526.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 16040.6 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7526.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7526.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 14503.49 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7799.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6215.35 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7799.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14503.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7526.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7799.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7526.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9872.72 } ] } ] }, { "description": "HC X-RAY LEG, INFANT", "code_information": [ { "code": "73592", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 596.56, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 520.2003, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 410.95, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 328.77, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 210.61 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.22, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC DOPPLER CW/PW LIMITED (93321)", "code_information": [ { "code": "93321", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 635.31, "minimum": 190.593, "maximum": 553.9903, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 341.54, "10th_percentile": 341.54, "90th_percentile": 341.54, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.3, "median_amount": 387.79, "10th_percentile": 387.79, "90th_percentile": 387.79, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 395.11, "10th_percentile": 387.64, "90th_percentile": 395.11, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.66, "median_amount": 389.62, "10th_percentile": 389.62, "90th_percentile": 389.62, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 109.2, "10th_percentile": 109.2, "90th_percentile": 109.2, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 443.19, "10th_percentile": 443.19, "90th_percentile": 447.26, "count": "1 through 10" } ] } ] }, { "description": "Hyaluronidase Human Inj 150 Unit/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "18657011702", "type": "NDC" }, { "code": "J3473", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC CLSD TREAT FEMUR SHAFT FX W MANIP", "code_information": [ { "code": "27502", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5920.94, "discounted_cash": 1586.0, "minimum": 1586.61, "maximum": 5920.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5920.94, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5920.94, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5920.94, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1729.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2683.27, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC SUPRAPUBIC TUBE PLACEMENT AND ASPIRATION", "code_information": [ { "code": "51102", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10440.9, "discounted_cash": 2062.0, "minimum": 2062.58, "maximum": 9870.8891, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8125.74, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9870.89, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7897.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2248.21, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2062.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3488.24, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "MAJOR SKIN DISORDERS WITHOUT MCC", "code_information": [ { "code": "596", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9280.0, "minimum": 7482.65, "maximum": 19560.6018, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8947.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 19560.6 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8947.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8947.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 8227.87 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9280.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7482.65 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9280.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8227.87 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8947.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 9280.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8947.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12039.22 } ] } ] }, { "description": "HC MRI BRAIN COMBO", "code_information": [ { "code": "70553", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3143.44, "discounted_cash": 344.0, "minimum": 344.22, "maximum": 2741.0797, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1689.91, "10th_percentile": 1689.91, "90th_percentile": 1689.91, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1356.09, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1647.33, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1317.92, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 1954.97, "10th_percentile": 1918.0, "90th_percentile": 1954.97, "count": "18" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1933.49 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 852.97, "10th_percentile": 852.97, "90th_percentile": 852.97, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 375.2, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 2192.86, "10th_percentile": 704.98, "90th_percentile": 2212.98, "count": "20" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 582.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A7048) VACUUM DRAIN BOTTLE/TUBE KIT", "code_information": [ { "code": "A7048", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 58.0, "minimum": 57.2001, "maximum": 99.544, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 58.86, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 71.5, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 57.2, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 58.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 58.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 64.16, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 58.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 58.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 99.54, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "NEUROSES EXCEPT DEPRESSIVE", "code_information": [ { "code": "882", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9214.0, "minimum": 6658.32, "maximum": 19403.3942, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8884.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 19403.39 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 8884.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 8884.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 11717.36 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 9214.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6658.32 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9214.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11717.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8884.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 9214.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8884.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11942.46 } ] } ] }, { "description": "HC ASSAY OF PROGESTERONE 17-D", "code_information": [ { "code": "83498", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 275.31, "discounted_cash": 27.0, "minimum": 26.4038, "maximum": 240.0703, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 121.45, "10th_percentile": 121.45, "90th_percentile": 121.45, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 33.0, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 26.4, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 148.16, "10th_percentile": 148.16, "90th_percentile": 151.0, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 142.57 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.62, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 192.06, "10th_percentile": 192.06, "90th_percentile": 193.82, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 45.95, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CHROMOTOGRAPHY, QUANT, SINGLE", "code_information": [ { "code": "82542", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1084.38, "discounted_cash": 24.0, "minimum": 23.4107, "maximum": 945.5794, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 29.26, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 23.41, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 126.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.26, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 126.41, "10th_percentile": 126.41, "90th_percentile": 126.41, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.74, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "ENDOCRINE DISORDERS WITH MCC", "code_information": [ { "code": "643", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13567.0, "minimum": 11470.72, "maximum": 35869.6351, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13060.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 29744.76 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 13060.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 31373.59, "standard_charge_algorithm": "76.27% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 18190.7, "10th_percentile": 18190.7, "90th_percentile": 18190.7, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 13060.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 26006.53 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 13567.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11470.72 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13567.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26006.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13060.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 13567.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13060.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18307.4 } ] } ] }, { "description": "HC I&D BREAST LESION", "code_information": [ { "code": "19000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2984.06, "discounted_cash": 698.0, "minimum": 698.71, "maximum": 2984.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 1873.99, "10th_percentile": 1873.99, "90th_percentile": 1873.99, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2752.64, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2984.06, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2675.15, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 761.59, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 698.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1181.66, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC REPLANTATION THUMB COMPLETE", "code_information": [ { "code": "20827", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5450.63, "discounted_cash": 1586.0, "minimum": 1586.61, "maximum": 5450.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5450.63, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 5450.63, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5450.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1729.4, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1586.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2683.27, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "CESAREAN SECTION WITH STERILIZATION WITH MCC", "code_information": [ { "code": "783", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19720.0, "minimum": 12749.78, "maximum": 44363.2642, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18964.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 44363.26 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 18964.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 18964.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 27682.11 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 19720.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12749.78 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19720.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 27682.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18964.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 19720.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18964.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27304.84 } ] } ] }, { "description": "Sodium Chloride IV Soln 3%", "drug_information": { "unit": 500.0, "type": "ML" }, "code_information": [ { "code": "63323053021", "type": "NDC" }, { "code": "J7131", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC (SUP SHELL Q4102) OASIS WOUND MATRIX PER SQ CM", "code_information": [ { "code": "Q4102", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 25.8215, "maximum": 605.4868, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.82 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CATHETER ASPIRATN NASOTRACH", "code_information": [ { "code": "31720", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 855.31, "discounted_cash": 216.0, "minimum": 216.06, "maximum": 855.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 216.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 851.19, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 855.31, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 216.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 827.23, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 216.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 216.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 216.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 235.51, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 216.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 216.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 216.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 216.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 216.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 365.4, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS", "code_information": [ { "code": "876", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 30442.0, "minimum": 27198.06, "maximum": 83619.14, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 29253.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 69838.12 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 29253.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 29253.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 83619.14 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 30442.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27198.06 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 30442.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 83619.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 29253.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 30442.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 29253.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 42984.18 } ] } ] }, { "description": "HC TEST FOR CHLOROHYDROCARBONS", "code_information": [ { "code": "82441", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 264.06, "discounted_cash": 6.0, "minimum": 5.8405, "maximum": 230.2603, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.84, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.54 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.55, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.16, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CLSD TREAT TRAUMATIC HIP DISLOC WO ANES", "code_information": [ { "code": "27250", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 878.75, "discounted_cash": 243.0, "minimum": 243.38, "maximum": 878.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 878.75, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.28, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 411.6, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC BIOPSY SALIVARY GLAND INCISIONAL", "code_information": [ { "code": "42405", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4649.69, "discounted_cash": 1530.0, "minimum": 1394.907, "maximum": 4649.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4649.69, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4649.69, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4649.69, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1668.74, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1530.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2589.14, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC MRA LOWER EXTREM W CONTRAST - 73725 - 61600001", "code_information": [ { "code": "73725", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4708.75, "minimum": 900.0, "maximum": 4106.03, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2293.23 } ] } ] }, { "description": "CORONARY BYPASS WITH PTCA WITHOUT MCC", "code_information": [ { "code": "232", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 47156.0, "minimum": 42280.33, "maximum": 162929.7661, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 45291.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 109550.21 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 45291.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 45291.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 131113.99 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 47156.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42280.33 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 47156.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 131114.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 45291.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 47156.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 45291.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 67426.3 } ] } ] }, { "description": "ALLERGIC REACTIONS WITHOUT MCC", "code_information": [ { "code": "916", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6115.0, "minimum": 4596.46, "maximum": 15212.2667, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 5910.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 12039.93 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 5910.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 5910.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 9864.48 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 6115.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4596.46 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6115.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9864.48 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5910.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 6115.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 5910.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7410.38 } ] } ] }, { "description": "HC BX BREAST W DEVICE MRI GUIDE 1ST LESION", "code_information": [ { "code": "19085", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5855.63, "discounted_cash": 1629.0, "minimum": 900.0, "maximum": 5855.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5855.63, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5855.63, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5855.63, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1776.31, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1629.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2756.05, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC ULTRASOUND,TRANSVAGINAL", "code_information": [ { "code": "76830", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 718.13, "discounted_cash": 103.0, "minimum": 103.15, "maximum": 718.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 364.22, "10th_percentile": 364.22, "90th_percentile": 364.22, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.37, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 493.64, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 394.93, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.4, "median_amount": 500.96, "10th_percentile": 500.96, "90th_percentile": 500.96, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.27, "median_amount": 421.35, "10th_percentile": 421.35, "90th_percentile": 438.17, "count": "24" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 718.13 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 335.88, "10th_percentile": 335.88, "90th_percentile": 353.8, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.43, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 476.96, "10th_percentile": 220.21, "90th_percentile": 500.96, "count": "20" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 174.45, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6450) LT COMPRES BAND >=5/YD - A6450 - 27090040", "code_information": [ { "code": "A6450", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 2.0, "minimum": 2.4295, "maximum": 4.228, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.04, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2.43, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.73, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.5, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC HEART FIRST PASS ADD-ON", "code_information": [ { "code": "78496", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1081.56, "minimum": 166.7621, "maximum": 943.1203, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 166.76 } ] } ] }, { "description": "VEIN LIGATION AND STRIPPING", "code_information": [ { "code": "263", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24300.0, "minimum": 18563.7, "maximum": 61505.41, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 23360.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 55246.73 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 23360.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 23360.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 61505.41 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 24300.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18563.7 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24300.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 61505.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 23360.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 24300.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 23360.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34003.42 } ] } ] }, { "description": "HC INDUC ARRHYTH BY HEART RHYTHM PACING", "code_information": [ { "code": "93618", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3523.13, "discounted_cash": 1201.0, "minimum": 1056.939, "maximum": 3523.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3523.13, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1309.46, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1201.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2031.71, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A7002) TUBING USED W SUCTION PUMP", "code_information": [ { "code": "A7002", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 5.0, "minimum": 5.1603, "maximum": 8.9803, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.31, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.45, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 5.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.79, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 5.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.98, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "DIABETES WITH CC", "code_information": [ { "code": "638", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7863.0, "minimum": 6348.24, "maximum": 22192.5776, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 7588.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 16194.19 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "case rate", "standard_charge_dollar": 7588.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 19410.87, "standard_charge_algorithm": "76.27% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 16027.25, "10th_percentile": 16027.25, "90th_percentile": 16027.25, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "other", "standard_charge_dollar": 19471.95, "standard_charge_algorithm": "76.51% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 15550.85, "10th_percentile": 15550.85, "90th_percentile": 24636.21, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 7588.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "case rate", "standard_charge_dollar": 12005.71 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "other", "standard_charge_dollar": 22141.68, "standard_charge_algorithm": "87% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 41618.83, "10th_percentile": 41618.83, "90th_percentile": 41618.83, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 7863.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6348.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7863.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12005.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 22192.58, "standard_charge_algorithm": "87.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 14181.71, "10th_percentile": 14181.71, "90th_percentile": 28639.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7588.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "case rate", "standard_charge_dollar": 7863.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7588.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9967.25 } ] } ] }, { "description": "HC (SUP SHELL L4360) PNEUMAT WALKING BOOT PRE CST", "code_information": [ { "code": "L4360", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 424.0, "minimum": 412.2764, "maximum": 717.4747, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 424.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 424.24, "additional_payer_notes": "A Indicator - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 515.32, "additional_payer_notes": "A Indicator - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 424.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 412.28, "additional_payer_notes": "A Indicator - 97.18% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 424.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 424.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 424.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 462.42, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 424.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 424.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 424.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 424.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 424.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 717.47, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL Q4256) MLG COMPLET, PER SQ CM", "code_information": [ { "code": "Q4256", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "minimum": 126.52, "maximum": 2010.293, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 498.44, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 605.49, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 484.41, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2010.29 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.91, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.97, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC CATH PLC/COR ANGIO RS/I BYPAS ANGIO W R HT CATH", "code_information": [ { "code": "93457", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16181.9, "discounted_cash": 3198.0, "minimum": 3198.82, "maximum": 15308.5929, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12602.07, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15308.59, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12247.32, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3486.71, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3198.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5409.84, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC OPEN/PERQ PLACEMENT INTRAVASCULAR STENT INITIAL", "code_information": [ { "code": "37236", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 39143.8, "discounted_cash": 11390.0, "minimum": 11390.68, "maximum": 39143.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 39143.8, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 39143.8, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 39143.8, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12415.84, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11390.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19263.92, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC FRAGMENT KIDNEY STONE/ ESWL", "code_information": [ { "code": "50590", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 175.0, "discounted_cash": 3478.0, "minimum": 52.5, "maximum": 175.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 175.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 175.0, "additional_payer_notes": "393.96% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 175.0, "additional_payer_notes": "478.57% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 175.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 175.0, "additional_payer_notes": "382.87% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 175.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 175.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 175.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 175.0, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 175.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 175.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 175.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 175.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 175.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 175.0, "additional_payer_notes": "169.12% of Medicare Rates" } ] } ] }, { "description": "HC GONADOTROPIN (LH)", "code_information": [ { "code": "83002", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 288.75, "discounted_cash": 18.0, "minimum": 17.9977, "maximum": 251.79, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.2, "median_amount": 201.43, "10th_percentile": 97.18, "90th_percentile": 203.28, "count": "19" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.32, "additional_payer_notes": "169.12% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 184.8, "10th_percentile": 155.23, "90th_percentile": 184.8, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "Laboratory - 100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.5, "additional_payer_notes": "Laboratory - 121.47% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 18.0, "additional_payer_notes": "Laboratory - 97.18% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 147.15, "10th_percentile": 147.15, "90th_percentile": 147.15, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.27, "median_amount": 155.39, "10th_percentile": 155.39, "90th_percentile": 158.37, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 97.18 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Martins Point", "plan_name": "Martins Point", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 87.0, "median_amount": 46.62, "10th_percentile": 46.62, "90th_percentile": 82.78, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.19, "additional_payer_notes": "109.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC CHANGE PERCUT TUBE/DRAIN CATH W CONTRAST MONIT", "code_information": [ { "code": "75984", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1433.44, "minimum": 430.032, "maximum": 1249.9597, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 508.93 } ] } ] }, { "description": "HC CHEST X-RAY 1 VW", "code_information": [ { "code": "71045", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 319.06, "discounted_cash": 85.0, "minimum": 85.87, "maximum": 319.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.5, "median_amount": 171.53, "10th_percentile": 68.08, "90th_percentile": 171.53, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 319.06, "additional_payer_notes": "393.96% of Medicare Rates" }, { "