{ "hospital_name": "Rumford Hospital", "last_updated_on": "2026-04-29", "version": "3.0", "location_name": [ "Rumford Hospital" ], "hospital_address": [ "420 Franklin Street, Rumford, ME 04276" ], "license_information": { "license_number": "40084", "state": "ME" }, "attestation": { "attestation": "To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.", "confirm_attestation": true, "attester_name": "Allen Stefanek" }, "type_2_npi": [ "1205991122" ], "standard_charge_information": [ { "description": "HC CT SCAN,CERVICAL SPINE,W/O CONTRAST", "code_information": [ { "code": "72125", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2131.88, "discounted_cash": 618.0, "minimum": 618.2452, "maximum": 1933.6152, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 1246.98, "10th_percentile": 660.88, "90th_percentile": 1246.98, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 579.24, "10th_percentile": 306.99, "90th_percentile": 613.98, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 963.52 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 558.0, "10th_percentile": 558.0, "90th_percentile": 591.47, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 770.82 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 963.52 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 963.52 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 733.11 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1705.5, "10th_percentile": 1609.0, "90th_percentile": 1705.5, "count": "32" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 545.76, "10th_percentile": 514.88, "90th_percentile": 545.76, "count": "24" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 1473.84, "10th_percentile": 1473.84, "90th_percentile": 1473.84, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 545.76, "10th_percentile": 514.88, "90th_percentile": 545.76, "count": "15" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 545.76, "10th_percentile": 514.88, "90th_percentile": 547.06, "count": "17" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 545.76, "10th_percentile": 514.88, "90th_percentile": 547.06, "count": "1 through 10" } ] } ] }, { "description": "Furosemide Inj 10 MG/ML", "drug_information": { "unit": 4.0, "type": "ML" }, "code_information": [ { "code": "63323028003", "type": "NDC" }, { "code": "J1938", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC (SUP SHELL A4415) OST SKN BARR W/O CONV >4 SQI", "code_information": [ { "code": "A4415", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 8.55, "maximum": 26.45, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 26.45 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 21.16 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 26.45 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 26.45 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.55, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Procainamide HCl Inj 100 MG/ML", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "76329339905", "type": "NDC" }, { "code": "J2690", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 895.671, "maximum": 1335.77, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1017.53 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1335.77 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1068.61 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1335.77 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1335.77 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 895.67 } ] } ] }, { "description": "Sumatriptan Succinate Inj 6 MG/0.5ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00143963801", "type": "NDC" }, { "code": "J3030", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 118.881, "maximum": 1134.84, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1134.84 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 177.29 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 141.83 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 177.29 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 177.29 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 118.88 } ] } ] }, { "description": "HC ANGIO SPINAL SELECTV", "code_information": [ { "code": "75705", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4651.25, "discounted_cash": 1348.0, "minimum": 896.63, "maximum": 4218.6838, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 914.67 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1120.79 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 896.63 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1120.79 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1120.79 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1147.65 } ] } ] }, { "description": "HC EVAL FNA SMEAR TO DETRMIN ADEQUACY, EA ADD EVAL", "code_information": [ { "code": "88177", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 144.38, "discounted_cash": 41.0, "minimum": 41.8702, "maximum": 130.9527, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.67 } ] } ] }, { "description": "HC (SUP SHELL A4311) CATHETER W/O BAG 2-WAY LATEX", "code_information": [ { "code": "A4311", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 19.91, "maximum": 19.91, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 19.91, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "VIRAL MENINGITIS WITH CCMCC", "code_information": [ { "code": "075", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12329.0, "minimum": 12329.57, "maximum": 22605.37, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22605.37 } ] } ] }, { "description": "HC ASSAY OF TRANSCORTIN", "code_information": [ { "code": "84449", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 264.38, "discounted_cash": 76.0, "minimum": 18.0, "maximum": 239.7927, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 145.17 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 177.89 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 142.31 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 177.89 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 177.89 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 166.87 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18.0, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "143", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13898.0, "minimum": 13898.79, "maximum": 44168.59, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 44168.59 } ] } ] }, { "description": "ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC", "code_information": [ { "code": "391", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8518.0, "minimum": 8518.61, "maximum": 20543.229, "payers_information": [ { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "other", "standard_charge_dollar": 8518.61, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 28083.52, "10th_percentile": 28083.52, "90th_percentile": 28083.52, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14951.96 } ] } ] }, { "description": "HC X-RAY ARM, INFANT", "code_information": [ { "code": "73092", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 542.5, "discounted_cash": 157.0, "minimum": 77.24, "maximum": 492.0475, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 78.79 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 96.55 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 77.24 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 96.55 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 96.55 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 203.03 } ] } ] }, { "description": "HC X-RAY HUMERUS", "code_information": [ { "code": "73060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 517.19, "discounted_cash": 149.0, "minimum": 80.1, "maximum": 469.0913, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 317.76, "10th_percentile": 317.76, "90th_percentile": 317.76, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 148.95, "10th_percentile": 140.49, "90th_percentile": 148.95, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 81.71 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 100.12 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 143.49, "10th_percentile": 143.49, "90th_percentile": 143.49, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 80.1 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 100.12 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 100.12 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 248.59, "10th_percentile": 248.59, "90th_percentile": 248.59, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 205.83 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 171.45, "10th_percentile": 171.45, "90th_percentile": 270.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 413.75, "10th_percentile": 390.25, "90th_percentile": 413.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 124.88, "10th_percentile": 124.88, "90th_percentile": 132.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 357.47, "10th_percentile": 357.47, "90th_percentile": 357.47, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 132.4, "10th_percentile": 132.4, "90th_percentile": 132.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 132.4, "10th_percentile": 132.4, "90th_percentile": 132.4, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 132.4, "10th_percentile": 132.4, "90th_percentile": 132.4, "count": "1 through 10" } ] } ] }, { "description": "HC MRI JOINT UPPER EXTREM WO CONTRAST", "code_information": [ { "code": "73221", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2668.44, "discounted_cash": 773.0, "minimum": 773.8476, "maximum": 2420.2751, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1725.03 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1380.01 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1725.03 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1725.03 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1226.59 } ] } ] }, { "description": "HC ANTIDEPRESSANTS SEROTONERGIC CLASS 1 OR 2 - G0480 - 31080332", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 114.06, "minimum": 33.0774, "maximum": 1060.8233, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 114.06 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 114.06 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 114.06 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 114.06 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 114.06 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 173.49, "10th_percentile": 173.49, "90th_percentile": 173.49, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 114.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 432.75, "10th_percentile": 164.25, "90th_percentile": 1052.5, "count": "14" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 95.76, "10th_percentile": 95.76, "90th_percentile": 95.76, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 363.48, "10th_percentile": 363.48, "90th_percentile": 375.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 132.48, "10th_percentile": 132.48, "90th_percentile": 257.04, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 132.77, "10th_percentile": 132.77, "90th_percentile": 337.54, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 55.85, "10th_percentile": 55.85, "90th_percentile": 55.85, "count": "1 through 10" } ] } ] }, { "description": "Vedolizumab For IV Solution 300 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "64764030020", "type": "NDC" }, { "code": "J3380", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 66.654, "maximum": 288.38, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 288.38 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 99.41 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 79.52 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 99.41 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 99.41 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 66.65 } ] } ] }, { "description": "SYNCOPE AND COLLAPSE", "code_information": [ { "code": "312", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5380.0, "minimum": 5380.18, "maximum": 11127.654, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 5380.18, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 6431.46, "10th_percentile": 6431.46, "90th_percentile": 6431.46, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10275.27 } ] } ] }, { "description": "OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH MCC", "code_information": [ { "code": "843", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12105.0, "minimum": 12105.4, "maximum": 23516.66, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23516.66 } ] } ] }, { "description": "INFLAMMATORY BOWEL DISEASE WITH MCC", "code_information": [ { "code": "385", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10760.0, "minimum": 10760.35, "maximum": 18653.7, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18653.7 } ] } ] }, { "description": "TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CCMCC", "code_information": [ { "code": "087", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4259.0, "minimum": 4259.31, "maximum": 10783.38, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10783.38 } ] } ] }, { "description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC", "code_information": [ { "code": "474", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21969.0, "minimum": 21969.05, "maximum": 50608.91, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 50608.91 } ] } ] }, { "description": "HC COMPLEMENT, ANTIGEN", "code_information": [ { "code": "86160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 163.44, "discounted_cash": 47.0, "minimum": 12.0, "maximum": 148.2401, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 147.5, "10th_percentile": 147.5, "90th_percentile": 147.5, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 44.37, "10th_percentile": 44.37, "90th_percentile": 44.37, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 92.03 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 112.77 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 90.22 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 112.77 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 112.77 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 111.25 }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 130.75, "10th_percentile": 123.25, "90th_percentile": 206.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 41.84, "10th_percentile": 39.44, "90th_percentile": 83.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 39.44, "10th_percentile": 39.44, "90th_percentile": 41.84, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 41.84, "10th_percentile": 41.84, "90th_percentile": 83.68, "count": "1 through 10" } ] } ] }, { "description": "HC ORAL SPEECH DEVICE EVAL", "code_information": [ { "code": "92597", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 438.75, "discounted_cash": 127.0, "minimum": 68.54, "maximum": 397.9463, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 68.54, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY SKULL <4 VW", "code_information": [ { "code": "70250", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 490.63, "discounted_cash": 142.0, "minimum": 94.37, "maximum": 445.0014, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 96.27 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 117.96 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 94.37 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 117.96 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 117.96 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 234.04 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 370.25, "10th_percentile": 370.25, "90th_percentile": 370.25, "count": "1 through 10" } ] } ] }, { "description": "HC CYTOPATH TBS CERV/VAG MANUAL", "code_information": [ { "code": "88164", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 124.38, "discounted_cash": 36.0, "minimum": 18.54, "maximum": 124.38, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 87.17 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 106.81 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 85.45 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 106.81 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 106.81 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 124.38 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC", "code_information": [ { "code": "178", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6949.0, "minimum": 6949.39, "maximum": 11554.983, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "other", "standard_charge_dollar": 6949.39, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 10719.1, "10th_percentile": 10719.1, "90th_percentile": 10719.1, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 6949.39, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 6431.46, "10th_percentile": 6431.46, "90th_percentile": 6431.46, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11506.04 } ] } ] }, { "description": "NONTRAUMATIC STUPOR AND COMA WITHOUT MCC", "code_information": [ { "code": "081", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6276.0, "minimum": 6276.87, "maximum": 10558.21, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10558.21 } ] } ] }, { "description": "HC ASSAY OF LIDOCAINE", "code_information": [ { "code": "80176", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 137.81, "discounted_cash": 39.0, "minimum": 14.69, "maximum": 137.81, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 121.26 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 137.81 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 118.87 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 137.81 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 137.81 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 136.18 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CCMCC", "code_information": [ { "code": "488", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4931.0, "minimum": 4931.83, "maximum": 20853.53, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20853.53 } ] } ] }, { "description": "HC CHEST X-RAY 4 VW", "code_information": [ { "code": "71048", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 610.0, "discounted_cash": 176.0, "minimum": 102.78, "maximum": 553.27, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 104.84 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 128.47 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 102.78 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 128.47 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 128.47 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 265.04 } ] } ] }, { "description": "HC (SUP SHELL L3670) SHOULDER ORTHOS ACROMIO/CLAV PREFAB", "code_information": [ { "code": "L3670", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 127.15, "maximum": 127.15, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 127.15, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC MNT SUBS TX FOR CHANGE DX", "code_information": [ { "code": "G0270", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 30.31, "minimum": 8.7899, "maximum": 27.4912, "payers_information": [ { "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" } ] } ] }, { "description": "Diazepam Inj 5 MG/ML", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "00409127332", "type": "NDC" }, { "code": "J3360", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 18.2385, "maximum": 102.29, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 102.29 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 27.2 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 21.76 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 27.2 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 27.2 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.24 } ] } ] }, { "description": "HC (SUP SHELL A6214) FOAM DRG > 48 SQ IN W/BORDER", "code_information": [ { "code": "A6214", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 14.68, "maximum": 14.68, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.68, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF PROINSULIN", "code_information": [ { "code": "84206", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 255.31, "discounted_cash": 74.0, "minimum": 26.69, "maximum": 247.4296, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 147.04 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 180.17 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 144.14 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 180.17 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 180.17 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 247.43 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 26.69, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L8670) VASCULAR GRAFT, SYNTHETIC", "code_information": [ { "code": "L8670", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 681.49, "maximum": 681.49, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 681.49, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC IV INFU, HYDRATION, EA ADD HOUR", "code_information": [ { "code": "96361", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 405.0, "discounted_cash": 117.0, "minimum": 117.45, "maximum": 367.335, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 183.48, "10th_percentile": 183.48, "90th_percentile": 366.95, "count": "38" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 164.1, "10th_percentile": 164.1, "90th_percentile": 328.21, "count": "25" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 88.18, "10th_percentile": 88.18, "90th_percentile": 88.87, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 1438.35, "10th_percentile": 256.25, "90th_percentile": 2796.75, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 131.25, "10th_percentile": 131.25, "90th_percentile": 131.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 256.25, "10th_percentile": 256.25, "90th_percentile": 4830.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 82.0, "10th_percentile": 82.0, "90th_percentile": 732.24, "count": "12" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 82.0, "10th_percentile": 82.0, "90th_percentile": 82.0, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 82.0, "10th_percentile": 82.0, "90th_percentile": 82.0, "count": "1 through 10" } ] } ] }, { "description": "INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "352", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4259.0, "minimum": 4259.31, "maximum": 13767.17, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13767.17 } ] } ] }, { "description": "BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CCMCC", "code_information": [ { "code": "520", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4707.0, "minimum": 4707.65, "maximum": 17611.56, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17611.56 } ] } ] }, { "description": "HC (SUP SHELL A4624) TRACHEAL SUCTION TUBE - A4624 - RU272034", "code_information": [ { "code": "A4624", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 3.2, "maximum": 3.2, "payers_information": [ { "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" } ] } ] }, { "description": "OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH MCC", "code_information": [ { "code": "154", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8742.0, "minimum": 8742.79, "maximum": 18432.07, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18432.07 } ] } ] }, { "description": "HC NM LUNG PERFUSION IMAGING", "code_information": [ { "code": "78580", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1223.13, "discounted_cash": 354.0, "minimum": 354.7077, "maximum": 1223.13, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 676.91 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 829.45 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 663.56 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 829.45 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 829.45 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1223.13 } ] } ] }, { "description": "Dextrose Inj 5% - 00264751010 - 25800001", "drug_information": { "unit": 500.0, "type": "ML" }, "code_information": [ { "code": "00264751010", "type": "NDC" }, { "code": "J7070", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 11.466, "maximum": 65.98, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 65.98 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.29 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13.83 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 17.29 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 17.29 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.47 } ] } ] }, { "description": "HC CANDIDA, ANTIBODY", "code_information": [ { "code": "86628", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 43.75, "discounted_cash": 12.0, "minimum": 12.01, "maximum": 43.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 43.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 43.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 43.75 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 43.75 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 43.75 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 43.75 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "100.00% 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, "discounted_cash": 1365.0, "minimum": 900.0, "maximum": 4270.8363, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2120.1 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1696.07 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2120.1 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2120.1 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2210.68 } ] } ] }, { "description": "HC ASSAY RBC PROTOPORPHYRIN", "code_information": [ { "code": "84202", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 439.38, "discounted_cash": 127.0, "minimum": 14.35, "maximum": 398.5177, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 118.43 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 145.12 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 116.1 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 145.12 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 145.12 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 133.03 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.35, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC DRUG ASSAY VORICONAZOLE", "code_information": [ { "code": "80285", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 300.0, "discounted_cash": 87.0, "minimum": 27.11, "maximum": 272.1, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 251.32 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 27.11, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC", "code_information": [ { "code": "814", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10536.0, "minimum": 10536.18, "maximum": 25071.62, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25071.62 } ] } ] }, { "description": "HC X-RAY URETHROCYSTOGRAM", "code_information": [ { "code": "74450", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1323.75, "discounted_cash": 383.0, "minimum": 230.25, "maximum": 1200.6412, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 234.89 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 287.82 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 230.25 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 287.82 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 287.82 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 434.27 } ] } ] }, { "description": "Piperacillin Sod-Tazobactam Sod For Inj 4.5 GM (4-0.5 GM)", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "60505615900", "type": "NDC" }, { "code": "J2543", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 3.528, "maximum": 40.14, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 40.14 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.26 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.21 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 5.26 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 5.26 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.53 } ] } ] }, { "description": "CARDIAC DEFIBRILLATOR IMPLANT WITHOUT MCC", "code_information": [ { "code": "277", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7397.0, "minimum": 7397.74, "maximum": 54447.4, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 54447.4 } ] } ] }, { "description": "CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA", "code_information": [ { "code": "955", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19503.0, "minimum": 19503.14, "maximum": 79352.8, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 79352.8 } ] } ] }, { "description": "HC ASSAY OF CADMIUM", "code_information": [ { "code": "82300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 76.25, "discounted_cash": 22.0, "minimum": 22.1125, "maximum": 76.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 76.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 76.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 76.25 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 76.25 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 76.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 76.25 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Ampicillin & Sulbactam Sodium For Inj 1.5 (1-0.5) GM", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "44567021010", "type": "NDC" }, { "code": "J0295", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 4.9455, "maximum": 35.12, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 35.12 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.38 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.9 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 7.38 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 7.38 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.95 } ] } ] }, { "description": "MAJOR MALE PELVIC PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "708", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3138.0, "minimum": 3138.44, "maximum": 18086.65, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18086.65 } ] } ] }, { "description": "HC US INFT HIPS R-T IMG DYNAMIC REQ PHYS/QHP MANJ", "code_information": [ { "code": "76885", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 449.38, "discounted_cash": 130.0, "minimum": 130.3202, "maximum": 449.38, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 309.28 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 247.42 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 309.28 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 309.28 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 449.38 } ] } ] }, { "description": "HC XRAY SPINE, COMPLETE, 4-5 VW", "code_information": [ { "code": "72083", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 677.19, "discounted_cash": 196.0, "minimum": 196.3851, "maximum": 614.2113, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 530.15 } ] } ] }, { "description": "Methylergonovine Maleate Inj 0.2 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "51991014499", "type": "NDC" }, { "code": "J2210", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 67.0635, "maximum": 217.68, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 217.68 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 100.02 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 80.01 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 100.02 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 100.02 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 67.06 } ] } ] }, { "description": "HC (SUP SHELL Q4151) AMNIOBAND, GUARDIAN 1 SQ CM", "code_information": [ { "code": "Q4151", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 429.912, "maximum": 641.11, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 641.11 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 512.88 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 641.11 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 641.11 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 429.91 } ] } ] }, { "description": "HC USE OF SPEECH DEVICE SERVICE, 15MIN", "code_information": [ { "code": "92609", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 953.44, "discounted_cash": 276.0, "minimum": 95.0, "maximum": 864.7701, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 98.25, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY SCAPULA", "code_information": [ { "code": "73010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 415.63, "discounted_cash": 120.0, "minimum": 75.77, "maximum": 376.9764, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 77.3 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 94.72 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 75.77 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 94.72 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 94.72 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 129.69 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 332.5, "10th_percentile": 332.5, "90th_percentile": 332.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 106.68, "10th_percentile": 106.68, "90th_percentile": 106.68, "count": "1 through 10" } ] } ] }, { "description": "BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "585", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4483.0, "minimum": 4483.48, "maximum": 22742.12, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22742.12 } ] } ] }, { "description": "ATHEROSCLEROSIS WITH MCC", "code_information": [ { "code": "302", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6501.0, "minimum": 6501.05, "maximum": 14106.69, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14106.69 } ] } ] }, { "description": "HC GLUCOSE TEST", "code_information": [ { "code": "82950", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 85.31, "discounted_cash": 24.0, "minimum": 4.75, "maximum": 77.3762, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 68.35, "10th_percentile": 68.35, "90th_percentile": 68.35, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 39.18 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 48.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 38.4 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 48.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 48.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.03 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 4.75, "10th_percentile": 4.75, "90th_percentile": 4.75, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 51.7, "10th_percentile": 51.7, "90th_percentile": 51.7, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL A6210) FOAM DRG >16<=48 SQ IN W/O B - A6210 - 27200119", "code_information": [ { "code": "A6210", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 28.4, "maximum": 28.4, "payers_information": [ { "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" } ] } ] }, { "description": "HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH MCC", "code_information": [ { "code": "353", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12777.0, "minimum": 12777.92, "maximum": 34211.62, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34211.62 } ] } ] }, { "description": "CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR", "code_information": [ { "code": "023", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15916.0, "minimum": 15916.35, "maximum": 67554.39, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 67554.39 } ] } ] }, { "description": "HC X-RAYS FOR BONE AGE", "code_information": [ { "code": "77072", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 630.94, "discounted_cash": 182.0, "minimum": 54.36, "maximum": 572.2626, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 55.46 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 67.95 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 54.36 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 67.95 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 67.95 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 381.52, "10th_percentile": 381.52, "90th_percentile": 381.52, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 143.82 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 504.75, "10th_percentile": 504.75, "90th_percentile": 504.75, "count": "1 through 10" } ] } ] }, { "description": "FRACTURES OF FEMUR WITH MCC", "code_information": [ { "code": "533", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9639.0, "minimum": 9639.48, "maximum": 18481.58, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18481.58 } ] } ] }, { "description": "HC CLOT INHIB PROTEIN C,ANTIGEN", "code_information": [ { "code": "85302", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 87.19, "discounted_cash": 25.0, "minimum": 12.01, "maximum": 87.19, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 87.19 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 87.19 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 87.19 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 87.19 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 87.19 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 87.19 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC MR ANGIO, HEAD, COMBO", "code_information": [ { "code": "70546", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3685.63, "discounted_cash": 1068.0, "minimum": 900.0, "maximum": 3342.8664, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2668.87 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2135.09 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2668.87 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2668.87 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2286.83 } ] } ] }, { "description": "HC US GUIDE, VASCULAR ACCESS", "code_information": [ { "code": "76937", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 711.56, "discounted_cash": 206.0, "minimum": 82.95, "maximum": 645.3849, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 84.62 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 103.69 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 82.95 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 103.69 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 103.69 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 208.63 } ] } ] }, { "description": "PENIS PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "710", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3586.0, "minimum": 3586.78, "maximum": 16518.72, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16518.72 } ] } ] }, { "description": "HC US ABDOMINAL AORTA REAL TIME SCREEN STUDY AAA", "code_information": [ { "code": "76706", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 882.81, "discounted_cash": 256.0, "minimum": 256.0149, "maximum": 800.7087, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 254.25, "10th_percentile": 239.85, "90th_percentile": 254.25, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 332.62 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 231.06, "10th_percentile": 231.06, "90th_percentile": 231.06, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 266.1 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 332.62 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 332.62 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 685.17 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 226.0, "10th_percentile": 213.2, "90th_percentile": 226.53, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 666.25, "10th_percentile": 666.25, "90th_percentile": 666.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 226.0, "10th_percentile": 213.2, "90th_percentile": 226.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 213.2, "10th_percentile": 213.2, "90th_percentile": 226.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 226.0, "10th_percentile": 226.0, "90th_percentile": 226.0, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 226.53, "10th_percentile": 226.53, "90th_percentile": 226.53, "count": "1 through 10" } ] } ] }, { "description": "HC ASSAY OF CRYOGLOBULIN", "code_information": [ { "code": "82595", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 30.63, "discounted_cash": 8.0, "minimum": 6.47, "maximum": 30.63, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 30.63 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 30.63 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 30.63 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 30.63 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 30.63 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.63 }, { "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" } ] } ] }, { "description": "HC (SUP SHELL A4628) OROPHARYNGEAL SUCTION CATH - A4628 - RU272036", "code_information": [ { "code": "A4628", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 5.33, "maximum": 5.33, "payers_information": [ { "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" } ] } ] }, { "description": "HC (SUP SHELL Q4038) CAST SUP SHRT LEG FIBERGLASS", "code_information": [ { "code": "Q4038", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 52.48, "maximum": 52.48, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 52.48, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "NERVOUS SYSTEM NEOPLASMS WITHOUT MCC", "code_information": [ { "code": "055", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6501.0, "minimum": 6501.05, "maximum": 17517.7859, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "other", "standard_charge_dollar": 6793.6, "standard_charge_algorithm": "2342.62 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 16521.08, "10th_percentile": 16521.08, "90th_percentile": 16521.08, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12020.04 } ] } ] }, { "description": "HC VEN THROMBOSIS IMAGES, BILAT", "code_information": [ { "code": "78458", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1104.38, "discounted_cash": 320.0, "minimum": 320.2702, "maximum": 1104.38, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 644.8 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 790.1 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 632.08 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 790.1 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 790.1 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1104.38 } ] } ] }, { "description": "HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT MCC", "code_information": [ { "code": "002", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19054.0, "minimum": 19054.79, "maximum": 133590.36, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 133590.36 } ] } ] }, { "description": "MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC", "code_information": [ { "code": "470", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4259.0, "minimum": 4259.31, "maximum": 22739.76, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22739.76 } ] } ] }, { "description": "CONNECTIVE TISSUE DISORDERS WITH CC", "code_information": [ { "code": "546", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7621.0, "minimum": 7621.92, "maximum": 13597.41, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13597.41 } ] } ] }, { "description": "HC JAK2 TARGETED SEQUENCE ANALYSIS", "code_information": [ { "code": "81279", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 800.94, "discounted_cash": 232.0, "minimum": 185.2, "maximum": 800.94, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 800.94 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 185.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "166", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17037.0, "minimum": 17037.22, "maximum": 44063.67, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 44063.67 } ] } ] }, { "description": "HC ASSAY OF LITHIUM", "code_information": [ { "code": "80178", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 133.13, "discounted_cash": 38.0, "minimum": 6.61, "maximum": 120.7489, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 38.34, "10th_percentile": 36.18, "90th_percentile": 38.34, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 54.55 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 66.85 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 53.48 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 66.85 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 66.85 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 61.28 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 12.32, "10th_percentile": 12.32, "90th_percentile": 34.08, "count": "1 through 10" }, { "payer_name": "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 100.5, "10th_percentile": 100.5, "90th_percentile": 106.5, "count": "18" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 32.16, "10th_percentile": 32.16, "90th_percentile": 34.08, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 34.08, "10th_percentile": 32.16, "90th_percentile": 37.19, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 32.16, "10th_percentile": 32.16, "90th_percentile": 34.08, "count": "1 through 10" } ] } ] }, { "description": "HC CHEMOTHER,NON-HORMONE ANTI-NEOPL, SUB-Q/IM", "code_information": [ { "code": "96401", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 523.44, "discounted_cash": 151.0, "minimum": 151.7976, "maximum": 474.7601, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 268.17, "10th_percentile": 260.26, "90th_percentile": 268.17, "count": "12" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 127.6, "10th_percentile": 127.6, "90th_percentile": 127.6, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 134.0, "10th_percentile": 127.6, "90th_percentile": 147.54, "count": "13" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 134.0, "10th_percentile": 127.6, "90th_percentile": 134.0, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL A7015) AEROSOL MASK USED W NEBULIZE", "code_information": [ { "code": "A7015", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.55, "maximum": 33.73, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 33.73 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 26.98 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 33.73 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 33.73 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.55, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC GATED HEART, MULTIPLE", "code_information": [ { "code": "78473", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2774.69, "discounted_cash": 804.0, "minimum": 804.6601, "maximum": 2516.6438, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1120.4 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1372.87 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1098.29 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1372.87 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1372.87 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1700.33 } ] } ] }, { "description": "HC PHLEBOTOMY THERAPUTIC", "code_information": [ { "code": "99195", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 504.38, "discounted_cash": 146.0, "minimum": 146.2702, "maximum": 457.4727, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 145.26, "10th_percentile": 145.26, "90th_percentile": 145.26, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 258.4, "10th_percentile": 258.4, "90th_percentile": 258.4, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 80.33, "10th_percentile": 80.33, "90th_percentile": 129.12, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 384.25, "10th_percentile": 384.25, "90th_percentile": 384.25, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 122.96, "10th_percentile": 122.96, "90th_percentile": 142.17, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 129.12, "10th_percentile": 122.96, "90th_percentile": 130.65, "count": "1 through 10" } ] } ] }, { "description": "NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY", "code_information": [ { "code": "789", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4035.0, "minimum": 4035.13, "maximum": 21246.1, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21246.1 } ] } ] }, { "description": "NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC", "code_information": [ { "code": "067", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7621.0, "minimum": 7621.92, "maximum": 23276.691, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17314.47 } ] } ] }, { "description": "HC ASSAY GROWTH HORMONE (HGH)", "code_information": [ { "code": "83003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 281.88, "discounted_cash": 81.0, "minimum": 16.67, "maximum": 255.6652, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 137.6 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 168.6 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 134.88 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 168.6 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 168.6 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 154.54 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF MYOGLOBIN", "code_information": [ { "code": "83874", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 183.13, "discounted_cash": 53.0, "minimum": 12.92, "maximum": 166.0989, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 106.62 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 130.64 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 104.51 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 130.64 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 130.64 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 119.77 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY SINUSES 3+ VW", "code_information": [ { "code": "70220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 714.06, "discounted_cash": 207.0, "minimum": 104.4, "maximum": 647.6524, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 106.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 130.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 104.4 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 130.5 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 130.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 231.24 } ] } ] }, { "description": "HC HISTOCHEMICAL STAIN", "code_information": [ { "code": "88314", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 218.75, "discounted_cash": 63.0, "minimum": 63.4375, "maximum": 218.75, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 218.75 } ] } ] }, { "description": "Tobramycin Sulfate For Inj 1.2 GM", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "39822041201", "type": "NDC" }, { "code": "J3260", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 5.04, "maximum": 44.09, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 44.09 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.47 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.98 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 7.47 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 7.47 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.04 } ] } ] }, { "description": "Adenosine IV Soln 6 MG/2ML", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "63323065100", "type": "NDC" }, { "code": "J0153", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.2285, "maximum": 11.31, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.31 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.83 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.47 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.83 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.83 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.23 } ] } ] }, { "description": "HC X-RAY INTRODUCTN GI TUBE", "code_information": [ { "code": "74340", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 607.19, "discounted_cash": 176.0, "minimum": 176.0851, "maximum": 607.19, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 417.23 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 511.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 409.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 511.25 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 511.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 607.19 } ] } ] }, { "description": "HC (SUP SHELL A4371) SKIN BARRIER POWDER PER OZ", "code_information": [ { "code": "A4371", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 5.2, "maximum": 30.77, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 30.77 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 24.62 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 30.77 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 30.77 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC ORAL FUNCTION THERAPY, 15 MIN", "code_information": [ { "code": "92526", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 435.31, "discounted_cash": 126.0, "minimum": 80.92, "maximum": 394.8262, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 348.25, "10th_percentile": 348.25, "90th_percentile": 348.25, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 80.92, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL Q4172) PURAPLY OR PURAPLY AM", "code_information": [ { "code": "Q4172", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1288.58, "maximum": 1288.58, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1288.58 } ] } ] }, { "description": "HC ANTEGRADE UROGRAPHY RADIOLOGICAL SUPVJ & INTERPJ", "code_information": [ { "code": "74425", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1454.06, "discounted_cash": 421.0, "minimum": 201.63, "maximum": 1318.8324, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 205.68 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 252.03 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 201.63 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 252.03 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 252.03 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 950.28 } ] } ] }, { "description": "CORONARY BYPASS WITH PTCA WITH MCC", "code_information": [ { "code": "231", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23314.0, "minimum": 23314.1, "maximum": 99379.92, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 99379.92 } ] } ] }, { "description": "Lidocaine HCl Local Preservative Free (PF) Inj 1%", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "55150016209", "type": "NDC" }, { "code": "J2003", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 12.77, "10th_percentile": 12.77, "90th_percentile": 13.54, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITH CCMCC", "code_information": [ { "code": "734", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6949.0, "minimum": 6949.39, "maximum": 25110.53, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25110.53 } ] } ] }, { "description": "HC OBSTETRIC PANEL", "code_information": [ { "code": "80055", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 329.38, "discounted_cash": 95.0, "minimum": 47.81, "maximum": 329.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 202.37, "10th_percentile": 202.37, "90th_percentile": 202.37, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 329.38 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 47.81, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF ETHOSUXIMIDE", "code_information": [ { "code": "80168", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 57.19, "discounted_cash": 16.0, "minimum": 16.34, "maximum": 57.19, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 57.19 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 57.19 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 57.19 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 57.19 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 57.19 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 57.19 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF 5-HIAA", "code_information": [ { "code": "83497", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 184.06, "discounted_cash": 53.0, "minimum": 12.9, "maximum": 166.9424, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 130.44 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 104.35 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 130.44 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 130.44 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 119.59 }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 147.25, "10th_percentile": 147.25, "90th_percentile": 147.25, "count": "1 through 10" } ] } ] }, { "description": "HC HERPES SIMPLEX TEST, TYPE 1", "code_information": [ { "code": "86695", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 254.06, "discounted_cash": 73.0, "minimum": 13.19, "maximum": 230.4324, "payers_information": [ { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 133.34 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 133.34 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 122.28 }, { "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": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 108.82 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 133.34 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 106.68 } ] } ] }, { "description": "HC ASSAY OF PORPHYRINS URINE QUAN&FXJ", "code_information": [ { "code": "84120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 456.25, "discounted_cash": 132.0, "minimum": 14.71, "maximum": 413.8188, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 121.37 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 148.72 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 118.98 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 148.72 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 148.72 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 136.37 }, { "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" } ] } ] }, { "description": "HC CYTOPATH CERV/VAG THIN LAYER", "code_information": [ { "code": "88142", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 182.19, "discounted_cash": 52.0, "minimum": 20.26, "maximum": 182.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 104.36, "10th_percentile": 104.36, "90th_percentile": 104.36, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 52.47, "10th_percentile": 52.47, "90th_percentile": 52.47, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 167.22 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 182.19 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 50.55, "10th_percentile": 50.55, "90th_percentile": 50.55, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 163.92 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 182.19 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 182.19 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 92.84, "10th_percentile": 92.84, "90th_percentile": 92.84, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 114.56, "10th_percentile": 114.56, "90th_percentile": 116.76, "count": "13" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 182.19 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 33.88, "10th_percentile": 33.38, "90th_percentile": 33.88, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 20.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 145.75, "10th_percentile": 145.75, "90th_percentile": 145.75, "count": "118" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 46.64, "10th_percentile": 20.26, "90th_percentile": 46.64, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 132.19, "10th_percentile": 116.5, "90th_percentile": 133.51, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 46.64, "10th_percentile": 46.64, "90th_percentile": 46.64, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 46.64, "10th_percentile": 46.64, "90th_percentile": 49.56, "count": "1 through 10" } ] } ] }, { "description": "HC ASSAY OF BLOOD LIPOPROTEIN,HDL CHOLEST", "code_information": [ { "code": "83718", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 177.19, "discounted_cash": 51.0, "minimum": 8.19, "maximum": 160.7113, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 67.61 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 82.85 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 66.28 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 82.85 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 82.85 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 75.93 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC RBC SED RATE, NONAUTO", "code_information": [ { "code": "85651", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 103.13, "discounted_cash": 29.0, "minimum": 4.27, "maximum": 93.5389, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 55.67, "10th_percentile": 55.67, "90th_percentile": 63.36, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 27.99, "10th_percentile": 27.99, "90th_percentile": 29.7, "count": "32" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 29.28 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 35.88 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 28.61, "10th_percentile": 26.97, "90th_percentile": 28.61, "count": "33" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 28.71 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 35.88 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 35.88 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 52.55, "10th_percentile": 52.55, "90th_percentile": 52.55, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 64.85, "10th_percentile": 62.29, "90th_percentile": 64.85, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.59 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 77.75, "10th_percentile": 19.07, "90th_percentile": 82.5, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 19.18, "10th_percentile": 19.18, "90th_percentile": 19.18, "count": "1 through 10" }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 82.5, "10th_percentile": 77.75, "90th_percentile": 82.5, "count": "116" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 26.4, "10th_percentile": 24.88, "90th_percentile": 26.44, "count": "60" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 74.83, "10th_percentile": 71.22, "90th_percentile": 74.83, "count": "17" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 26.4, "10th_percentile": 24.88, "90th_percentile": 28.77, "count": "60" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 26.4, "10th_percentile": 4.27, "90th_percentile": 26.44, "count": "14" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 26.4, "10th_percentile": 26.4, "90th_percentile": 26.44, "count": "25" } ] } ] }, { "description": "HC ASSAY TOTAL HYDROXYPROLINE", "code_information": [ { "code": "83505", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 479.69, "discounted_cash": 139.0, "minimum": 24.3, "maximum": 435.0788, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 245.84 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 196.67 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 245.84 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 245.84 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 225.27 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 24.3, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT", "code_information": [ { "code": "77002", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1797.19, "discounted_cash": 521.0, "minimum": 174.46, "maximum": 1630.0513, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 177.98 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 218.08 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 174.46 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 218.08 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 218.08 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 758.52 } ] } ] }, { "description": "HC (SUP SHELL C1788) PORT INDWELLING", "code_information": [ { "code": "C1788", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 1068.35, "10th_percentile": 1068.35, "90th_percentile": 1068.35, "count": "1 through 10" } ] } ] }, { "description": "HC REMOVE,OBST MATL,CVA DEV VIA SEP VEN ACC", "code_information": [ { "code": "75901", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1305.94, "discounted_cash": 378.0, "minimum": 378.7226, "maximum": 1305.94, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 602.49 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 738.26 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 590.6 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 738.26 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 738.26 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1305.94 } ] } ] }, { "description": "HC RP LOCLZJ TUM SPECT 2 AREA 1D IMG/1 AREA IMG>2+D", "code_information": [ { "code": "78831", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6793.44, "discounted_cash": 1970.0, "minimum": 1970.0976, "maximum": 6161.6501, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4799.29 } ] } ] }, { "description": "Rabies Vaccine, PCEC For Inj", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "50632001001", "type": "NDC" }, { "code": "90675", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1000.6605, "maximum": 4247.12, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4247.12 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1492.35 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1193.87 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1492.35 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1492.35 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1000.66 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 317.67, "10th_percentile": 312.03, "90th_percentile": 327.78, "count": "13" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 1737.88, "10th_percentile": 1737.88, "90th_percentile": 1737.88, "count": "1 through 10" } ] } ] }, { "description": "HC WHEELCHAIR MNGMENT TRAIN EA 15 MIN", "code_information": [ { "code": "97542", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 113.44, "discounted_cash": 32.0, "minimum": 29.76, "maximum": 102.8901, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 29.76, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4369) SKIN BARRIER LIQUID PER OZ", "code_information": [ { "code": "A4369", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 3.46, "maximum": 3.46, "payers_information": [ { "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" } ] } ] }, { "description": "VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION ANDOR D&C", "code_information": [ { "code": "768", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6052.0, "minimum": 6052.7, "maximum": 12633.07, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12633.07 } ] } ] }, { "description": "SEIZURES WITHOUT MCC", "code_information": [ { "code": "101", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5828.0, "minimum": 5828.52, "maximum": 10640.73, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10640.73 } ] } ] }, { "description": "HC LEGIONELLA", "code_information": [ { "code": "86713", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 306.88, "discounted_cash": 88.0, "minimum": 15.3, "maximum": 278.3402, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 126.35 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 154.82 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 123.85 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 154.82 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 154.82 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 141.84 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC CT ANGIO ABD & PLVIS WO/W CONTRAST", "code_information": [ { "code": "74174", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3140.0, "discounted_cash": 910.0, "minimum": 650.0, "maximum": 2847.98, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2263.98 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1811.18 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2263.98 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2263.98 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2436.32 } ] } ] }, { "description": "OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CCMCC", "code_information": [ { "code": "316", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4035.0, "minimum": 4035.13, "maximum": 8041.26, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8041.26 } ] } ] }, { "description": "POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "858", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7621.0, "minimum": 7621.92, "maximum": 16420.87, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16420.87 } ] } ] }, { "description": "HC LYME DISEASE ANTIBODY", "code_information": [ { "code": "86618", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 303.13, "discounted_cash": 87.0, "minimum": 17.03, "maximum": 274.9389, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 163.79, "10th_percentile": 163.79, "90th_percentile": 177.28, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 87.3, "10th_percentile": 87.3, "90th_percentile": 87.3, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 117.98 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 144.57 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 84.1, "10th_percentile": 84.1, "90th_percentile": 84.1, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 115.65 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 144.57 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 144.57 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 145.71, "10th_percentile": 145.71, "90th_percentile": 154.47, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 190.61, "10th_percentile": 190.61, "90th_percentile": 381.21, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 157.88 }, { "payer_name": "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 242.5, "10th_percentile": 228.75, "90th_percentile": 242.5, "count": "39" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 77.6, "10th_percentile": 73.2, "90th_percentile": 77.6, "count": "13" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 209.54, "10th_percentile": 209.54, "90th_percentile": 219.95, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 77.6, "10th_percentile": 77.6, "90th_percentile": 77.6, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 77.6, "10th_percentile": 77.6, "90th_percentile": 77.6, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 77.6, "10th_percentile": 77.6, "90th_percentile": 77.6, "count": "1 through 10" } ] } ] }, { "description": "Magnesium Sulfate IV Soln 2 GM/50ML (40 MG/ML)", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "00338170840", "type": "NDC" }, { "code": "J3475", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.5435, "maximum": 7.51, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 124.7, "10th_percentile": 124.7, "90th_percentile": 124.7, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7.51 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2.3 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.84 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2.3 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2.3 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.54 } ] } ] }, { "description": "KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH MCC", "code_information": [ { "code": "656", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11208.0, "minimum": 11208.7, "maximum": 37533.75, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 37533.75 } ] } ] }, { "description": "OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CCMCC", "code_information": [ { "code": "093", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4931.0, "minimum": 4931.83, "maximum": 9387.56, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9387.56 } ] } ] }, { "description": "OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC", "code_information": [ { "code": "803", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8294.0, "minimum": 8294.44, "maximum": 21914.53, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21914.53 } ] } ] }, { "description": "HC MR SAFETY IMPLANT&/FB ASSMT CLIN STAFF EA ADD 30", "code_information": [ { "code": "76015", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 91.88, "discounted_cash": 26.0, "minimum": 26.6452, "maximum": 91.88, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 91.88 } ] } ] }, { "description": "HC (SUP SHELL Q4193) COLL-E-DERM 1 SQ CM", "code_information": [ { "code": "Q4193", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 5066.0505, "maximum": 9710.35, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9710.35 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7768.2 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 9710.35 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 9710.35 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5066.05 } ] } ] }, { "description": "HC (SUP SHELL L3931) WHFO NONTORSION JOINT PREFAB", "code_information": [ { "code": "L3931", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 232.07, "maximum": 232.07, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 232.07, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Pertuzumab-Trastuz-Hyaluron-zzxf Inj 60 MG-60 MG-2000 UNT/ML", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "50242026001", "type": "NDC" }, { "code": "J9316", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 198.4185, "maximum": 295.91, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 295.91 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 236.73 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 295.91 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 295.91 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 198.42 } ] } ] }, { "description": "OTHER FACTORS INFLUENCING HEALTH STATUS", "code_information": [ { "code": "951", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4035.0, "minimum": 4035.13, "maximum": 12017.0535, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6554.67 } ] } ] }, { "description": "BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CCMCC", "code_information": [ { "code": "410", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6501.0, "minimum": 6501.05, "maximum": 18717.36, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18717.36 } ] } ] }, { "description": "NON-MALIGNANT BREAST DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "601", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5156.0, "minimum": 5156.0, "maximum": 7132.33, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7132.33 } ] } ] }, { "description": "NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC", "code_information": [ { "code": "987", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17485.0, "minimum": 17485.57, "maximum": 40417.34, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 40417.34 } ] } ] }, { "description": "Ketorolac Tromethamine Inj 15 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "63323016100", "type": "NDC" }, { "code": "J1885", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.575, "maximum": 8.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 12.77, "10th_percentile": 12.77, "90th_percentile": 13.54, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.4 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2.35 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.88 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2.35 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2.35 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.58 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 6.25, "10th_percentile": 6.25, "90th_percentile": 6.25, "count": "1 through 10" } ] } ] }, { "description": "CAROTID ARTERY STENT PROCEDURES WITH CC", "code_information": [ { "code": "035", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4259.0, "minimum": 4259.31, "maximum": 28181.56, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28181.56 } ] } ] }, { "description": "HC ASSAY OF THYROGLOBULIN", "code_information": [ { "code": "84432", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 291.25, "discounted_cash": 84.0, "minimum": 16.06, "maximum": 264.1637, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 83.88, "10th_percentile": 83.88, "90th_percentile": 83.88, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 132.57 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 162.44 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 129.95 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 162.44 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 162.44 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 148.88 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 233.0, "10th_percentile": 233.0, "90th_percentile": 233.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 74.56, "10th_percentile": 74.56, "90th_percentile": 74.56, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 211.33, "10th_percentile": 211.33, "90th_percentile": 211.33, "count": "1 through 10" } ] } ] }, { "description": "HC GONADOTROPIN (LH)", "code_information": [ { "code": "83002", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 288.75, "discounted_cash": 83.0, "minimum": 18.52, "maximum": 261.8963, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 177.41, "10th_percentile": 177.41, "90th_percentile": 177.41, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 152.86 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 187.31 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 149.84 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 187.31 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 187.31 }, { "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": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 171.69 }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 231.0, "10th_percentile": 231.0, "90th_percentile": 231.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 73.92, "10th_percentile": 73.92, "90th_percentile": 78.54, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 209.52, "10th_percentile": 209.52, "90th_percentile": 211.6, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 73.92, "10th_percentile": 73.92, "90th_percentile": 85.47, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 73.92, "10th_percentile": 73.92, "90th_percentile": 73.92, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL A7520) TRACH/LARYN TUBE NON-CUFFED", "code_information": [ { "code": "A7520", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 67.66, "maximum": 67.66, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 67.66, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4330) STOOL COLLECTION POUCH - A4330 - 27100041", "code_information": [ { "code": "A4330", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 10.21, "maximum": 10.21, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 10.21, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF NOS VITAMIN", "code_information": [ { "code": "84591", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 334.06, "discounted_cash": 96.0, "minimum": 17.06, "maximum": 302.9924, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 95.71 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 117.27 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 93.82 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 117.27 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 117.27 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 158.15 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 256.08, "10th_percentile": 256.08, "90th_percentile": 256.08, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 17.06, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC", "code_information": [ { "code": "011", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 25555.0, "minimum": 25555.84, "maximum": 64298.28, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 64298.28 } ] } ] }, { "description": "HC ASSAY OF ARSENIC", "code_information": [ { "code": "82175", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 52.19, "discounted_cash": 15.0, "minimum": 15.1351, "maximum": 52.19, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 52.19 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 52.19 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 52.19 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 52.19 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 52.19 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 52.19 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 41.75, "10th_percentile": 41.75, "90th_percentile": 41.75, "count": "1 through 10" } ] } ] }, { "description": "HC RBC SICKLE CELL TEST", "code_information": [ { "code": "85660", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 460.0, "discounted_cash": 133.0, "minimum": 5.51, "maximum": 417.22, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 45.56 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 55.83 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 44.67 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 55.83 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 55.83 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 51.08 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.51, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS", "code_information": [ { "code": "208", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10984.0, "minimum": 10984.53, "maximum": 32404.37, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 32404.37 } ] } ] }, { "description": "HC (SUP SHELL L0464) TLSO 4MOD SACRO-SCAP PRE", "code_information": [ { "code": "L0464", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1782.97, "maximum": 1782.97, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1782.97, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC", "code_information": [ { "code": "863", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7397.0, "minimum": 7397.74, "maximum": 11764.22, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11764.22 } ] } ] }, { "description": "OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CCMCC", "code_information": [ { "code": "909", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4931.0, "minimum": 4931.83, "maximum": 15475.39, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15475.39 } ] } ] }, { "description": "HC (SUP SHELL A6448) LT COMPRES BAND <3/YD - A6448 - 27090038", "code_information": [ { "code": "A6448", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.64, "maximum": 1.64, "payers_information": [ { "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" } ] } ] }, { "description": "HC OCCUP THRP EVAL, MODERATE COMPLEXITY, 45 MIN", "code_information": [ { "code": "97166", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 626.88, "discounted_cash": 181.0, "minimum": 95.0, "maximum": 568.5802, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 180.54, "10th_percentile": 180.54, "90th_percentile": 180.54, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 96.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 69.39, "10th_percentile": 69.39, "90th_percentile": 69.39, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 160.48, "10th_percentile": 160.48, "90th_percentile": 160.48, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 160.48, "10th_percentile": 37.11, "90th_percentile": 160.48, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 160.48, "10th_percentile": 160.48, "90th_percentile": 160.48, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 160.48, "10th_percentile": 160.48, "90th_percentile": 160.48, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL A6022) COLLAGEN DRSG>16<=48 SQ IN - A6022 - 27200110", "code_information": [ { "code": "A6022", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 29.97, "maximum": 29.97, "payers_information": [ { "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" } ] } ] }, { "description": "PROSTATECTOMY WITHOUT CCMCC", "code_information": [ { "code": "667", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4707.0, "minimum": 4707.65, "maximum": 13040.97, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13040.97 } ] } ] }, { "description": "HC CHANGE PERCUT TUBE/DRAIN CATH W CONTRAST MONIT", "code_information": [ { "code": "75984", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1433.44, "discounted_cash": 415.0, "minimum": 304.6, "maximum": 1300.1301, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 310.73 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 380.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 304.6 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 380.75 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 380.75 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 490.61 } ] } ] }, { "description": "HC ASSAY SNGL ORGANIC ACID, QUANTITATIVE", "code_information": [ { "code": "83921", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 556.56, "discounted_cash": 161.0, "minimum": 21.21, "maximum": 504.7999, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 160.29, "10th_percentile": 160.29, "90th_percentile": 160.29, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 135.9 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 166.53 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 133.22 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 166.53 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 166.53 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 196.63 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 445.25, "10th_percentile": 347.86, "90th_percentile": 445.25, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 103.5, "10th_percentile": 103.5, "90th_percentile": 103.5, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 21.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 445.25, "10th_percentile": 445.25, "90th_percentile": 445.25, "count": "19" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 142.48, "10th_percentile": 142.48, "90th_percentile": 142.48, "count": "19" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 142.48, "10th_percentile": 142.48, "90th_percentile": 403.84, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 142.48, "10th_percentile": 142.48, "90th_percentile": 142.48, "count": "15" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 142.48, "10th_percentile": 142.48, "90th_percentile": 142.48, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL A4406) PECTIN BASED OSTOMY PASTE", "code_information": [ { "code": "A4406", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 8.16, "maximum": 19.26, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.26 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 15.41 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 19.26 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 19.26 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.16, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CCMCC", "code_information": [ { "code": "013", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14571.0, "minimum": 14571.31, "maximum": 33973.48, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 33973.48 } ] } ] }, { "description": "OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC", "code_information": [ { "code": "958", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14571.0, "minimum": 14571.31, "maximum": 49677.58, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 49677.58 } ] } ] }, { "description": "HC ASSAY OF LEAD", "code_information": [ { "code": "83655", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 150.94, "discounted_cash": 43.0, "minimum": 12.11, "maximum": 136.9026, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 99.89 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 122.4 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 97.92 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 122.4 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 122.4 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 112.27 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 120.75, "10th_percentile": 106.0, "90th_percentile": 120.75, "count": "35" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 96.14, "10th_percentile": 96.14, "90th_percentile": 109.52, "count": "1 through 10" } ] } ] }, { "description": "HC THYROID MET UPTAKE", "code_information": [ { "code": "78020", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 537.5, "discounted_cash": 155.0, "minimum": 155.875, "maximum": 487.5125, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 243.62 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 298.52 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 238.82 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 298.52 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 298.52 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 442.74 } ] } ] }, { "description": "HC ASSAY OF ESTRONE", "code_information": [ { "code": "82679", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 145.0, "discounted_cash": 42.0, "minimum": 24.95, "maximum": 145.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 145.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 145.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 145.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 145.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 145.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 145.0 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC", "code_information": [ { "code": "280", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9191.0, "minimum": 9191.13, "maximum": 18910.7, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18910.7 } ] } ] }, { "description": "HC PLATELET PHERESIS IRRADIATED, PER UNIT", "code_information": [ { "code": "P9036", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3839.69, "minimum": 1113.5101, "maximum": 3482.5988, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 1967.15, "10th_percentile": 1967.15, "90th_percentile": 1967.15, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 982.96, "10th_percentile": 982.96, "90th_percentile": 982.96, "count": "1 through 10" } ] } ] }, { "description": "CELLULITIS WITH MCC", "code_information": [ { "code": "602", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10087.0, "minimum": 10087.83, "maximum": 16755.68, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "other", "standard_charge_dollar": 10541.79, "standard_charge_algorithm": "2342.62 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 17706.57, "10th_percentile": 17706.57, "90th_percentile": 17706.57, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16755.68 } ] } ] }, { "description": "Deferoxamine Mesylate For Inj 500 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "60505623606", "type": "NDC" }, { "code": "J0895", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 25.8615, "maximum": 296.31, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 296.31 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 38.57 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 30.85 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 38.57 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 38.57 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.86 } ] } ] }, { "description": "Ondansetron Orally Disintegrating Tab 4 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "68462015740", "type": "NDC" }, { "code": "Q0162", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC FLUOROSCOPY SPX UP TO 1 HOUR PHYS/QHP TIME", "code_information": [ { "code": "76000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 663.13, "discounted_cash": 192.0, "minimum": 192.3077, "maximum": 601.4589, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 336.98 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 412.92 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 330.33 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 412.92 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 412.92 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 236.84 } ] } ] }, { "description": "HC (SUP SHELL A6403) STERILE GAUZE>16 <= 48 SQ IN - A6403 - RU272060", "code_information": [ { "code": "A6403", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "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" } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC", "code_information": [ { "code": "896", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10760.0, "minimum": 10760.35, "maximum": 26902.323, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20572.95 } ] } ] }, { "description": "HC (SUP SHELL Q4152) DERMAPURE 1 SQUARE CM", "code_information": [ { "code": "Q4152", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 172.053, "maximum": 1436.72, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1436.72 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 256.59 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 205.27 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 256.59 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 256.59 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 172.05 } ] } ] }, { "description": "DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC", "code_information": [ { "code": "056", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12777.0, "minimum": 12777.92, "maximum": 64492.0245, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27386.98 } ] } ] }, { "description": "Morphine Sulfate IV Soln PF 4 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00641612525", "type": "NDC" }, { "code": "J2270", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 14.5845, "maximum": 35.73, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 13.54, "10th_percentile": 13.54, "90th_percentile": 13.54, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 35.73 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 17.4 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 21.75 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 21.75 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.58 } ] } ] }, { "description": "EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT", "code_information": [ { "code": "927", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 53801.0, "minimum": 53801.76, "maximum": 251700.62, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 251700.62 } ] } ] }, { "description": "HC ASSAY OF BARBITURATES - G0480 - 30100326", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 208.75, "minimum": 33.0774, "maximum": 1060.8233, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 208.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 208.75 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 208.75 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 208.75 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 208.75 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 173.49, "10th_percentile": 173.49, "90th_percentile": 173.49, "count": "1 through 10" }, { "payer_name": "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 432.75, "10th_percentile": 164.25, "90th_percentile": 1052.5, "count": "14" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 95.76, "10th_percentile": 95.76, "90th_percentile": 95.76, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 363.48, "10th_percentile": 363.48, "90th_percentile": 375.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 132.48, "10th_percentile": 132.48, "90th_percentile": 257.04, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 132.77, "10th_percentile": 132.77, "90th_percentile": 337.54, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 55.85, "10th_percentile": 55.85, "90th_percentile": 55.85, "count": "1 through 10" } ] } ] }, { "description": "HC SARS-COV-2 COVID19 W/OPTIC", "code_information": [ { "code": "87811", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 62.5, "discounted_cash": 18.0, "minimum": 18.125, "maximum": 62.5, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 62.5 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 41.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 28.97, "10th_percentile": 28.97, "90th_percentile": 28.97, "count": "1 through 10" } ] } ] }, { "description": "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": 64.827, "maximum": 193.72, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 193.72 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 96.68 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 77.34 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 96.68 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 96.68 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 64.83 } ] } ] }, { "description": "HC INTUBATION ENDOTRACHEAL", "code_information": [ { "code": "31500", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 838.44, "discounted_cash": 243.0, "minimum": 243.1476, "maximum": 760.4651, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 480.26, "10th_percentile": 480.26, "90th_percentile": 480.26, "count": "1 through 10" } ] } ] }, { "description": "Epoetin Alfa Inj 10000 Unit/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "59676031001", "type": "NDC" }, { "code": "J0885", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 22.302, "maximum": 192.38, "payers_information": [ { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 33.26 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.3 }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 192.38 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 33.26 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 26.61 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 33.26 } ] } ] }, { "description": "HC (SUP SHELL C9354) ACCELLULR PERICARDIAL TISS NH SQ CM", "code_information": [ { "code": "C9354", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 61.047, "maximum": 61.047, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 61.05 } ] } ] }, { "description": "HC ULTRASOUND THERAPY EA 15 MIN", "code_information": [ { "code": "97035", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 117.5, "discounted_cash": 34.0, "minimum": 13.67, "maximum": 106.5725, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.67, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Fomepizole Inj 1 GM/ML (For IV Infusion)", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "70710147801", "type": "NDC" }, { "code": "J1451", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 40.6035, "maximum": 170.49, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 170.49 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 60.55 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 48.44 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 60.55 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 60.55 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.6 } ] } ] }, { "description": "HC (SUP SHELL A4390) DRAINABLE PCH EX WEAR CONVEX", "code_information": [ { "code": "A4390", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 13.68, "maximum": 13.68, "payers_information": [ { "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" } ] } ] }, { "description": "HC X-RAY STERNO-CLAVICLUAR JT", "code_information": [ { "code": "71130", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 557.19, "discounted_cash": 161.0, "minimum": 102.97, "maximum": 505.3713, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 105.05 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 128.72 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 102.97 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 128.72 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 128.72 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 262.24 } ] } ] }, { "description": "OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC", "code_information": [ { "code": "271", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8294.0, "minimum": 8294.44, "maximum": 41925.15, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 41925.15 } ] } ] }, { "description": "PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC", "code_information": [ { "code": "274", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 2690.0, "minimum": 2690.09, "maximum": 38805.79, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 38805.79 } ] } ] }, { "description": "HC EDUCATION&TRAINING SELF-MGMT NONPHYS 1 PT", "code_information": [ { "code": "98960", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 94.69, "discounted_cash": 27.0, "minimum": 27.4601, "maximum": 94.69, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 94.69 } ] } ] }, { "description": "HC (SUP SHELL Q4014) CAST SUP GAUNTLET FIBERGLASS", "code_information": [ { "code": "Q4014", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 33.84, "maximum": 33.84, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 33.84, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OSTEOMYELITIS WITH MCC", "code_information": [ { "code": "539", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13898.0, "minimum": 13898.79, "maximum": 37657.413, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "other", "standard_charge_dollar": 14524.24, "standard_charge_algorithm": "2342.62 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 7554.62, "10th_percentile": 7554.62, "90th_percentile": 7554.62, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23220.75 } ] } ] }, { "description": "HC MR ANGIO, NECK", "code_information": [ { "code": "70547", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1905.31, "discounted_cash": 552.0, "minimum": 552.5399, "maximum": 1728.1162, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1725.03 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1380.01 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1725.03 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1725.03 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1404.22 } ] } ] }, { "description": "HC T CELLS, TOTAL COUNT", "code_information": [ { "code": "86359", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 132.81, "discounted_cash": 38.0, "minimum": 37.73, "maximum": 132.81, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 94.58 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 115.89 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 92.71 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 115.89 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 115.89 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 83.51, "10th_percentile": 83.51, "90th_percentile": 83.51, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 132.81 }, { "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" } ] } ] }, { "description": "HC (SUP SHELL L2186) ADJ MOTION KNEE JNT LERMAN T", "code_information": [ { "code": "L2186", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 177.87, "maximum": 177.87, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 177.87, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC XRAY FEMUR 1 VW", "code_information": [ { "code": "73551", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 437.81, "discounted_cash": 126.0, "minimum": 126.9649, "maximum": 397.0937, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 180.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 112.08, "10th_percentile": 112.08, "90th_percentile": 112.08, "count": "1 through 10" } ] } ] }, { "description": "HC LEVEEN/SHUNT PATENCY EXAM", "code_information": [ { "code": "78291", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1046.25, "discounted_cash": 303.0, "minimum": 303.4125, "maximum": 1046.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 773.18 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 947.42 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 757.93 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 947.42 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 947.42 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1046.25 } ] } ] }, { "description": "HC (SUP SHELL A4432) OS PCH URINE W BAR/FANGE/TAP", "code_information": [ { "code": "A4432", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 5.11, "maximum": 5.11, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.11, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A7041) WATER SEAL DRAIN CONTAINER", "code_information": [ { "code": "A7041", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 105.73, "maximum": 105.73, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 105.73, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "828", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5380.0, "minimum": 5380.18, "maximum": 20086.06, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20086.06 } ] } ] }, { "description": "HC BLOOD FUNGUS CULTURE", "code_information": [ { "code": "87103", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 254.06, "discounted_cash": 73.0, "minimum": 20.46, "maximum": 230.4324, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 74.45 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 91.23 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 72.98 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 91.23 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 91.23 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 189.67 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 20.46, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF BENZODIAZEPINES - 80346 - 30100410", "code_information": [ { "code": "80346", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 352.81, "discounted_cash": 102.0, "minimum": 102.3149, "maximum": 319.9987, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 149.35 } ] } ] }, { "description": "HC US BONE DENSITY MEASURE,PERIPHERAL", "code_information": [ { "code": "76977", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 303.13, "discounted_cash": 87.0, "minimum": 39.4728, "maximum": 274.9389, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 57.2 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 45.76 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 57.2 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 57.2 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.47 } ] } ] }, { "description": "TESTES PROCEDURES WITH CCMCC", "code_information": [ { "code": "711", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10760.0, "minimum": 10760.35, "maximum": 24565.88, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24565.88 } ] } ] }, { "description": "HC (SUP SHELL C9360) SURGIMEND, NEONATAL", "code_information": [ { "code": "C9360", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 68.229, "maximum": 68.229, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 68.23 } ] } ] }, { "description": "HC COMPATIBILITY TEST,ANTIGLOB TECH", "code_information": [ { "code": "86922", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 255.0, "discounted_cash": 73.0, "minimum": 73.95, "maximum": 255.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 255.0 } ] } ] }, { "description": "OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITHOUT CCMCC", "code_information": [ { "code": "156", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4483.0, "minimum": 4483.48, "maximum": 8147.36, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8147.36 } ] } ] }, { "description": "NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC", "code_information": [ { "code": "988", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8966.0, "minimum": 8966.96, "maximum": 19376.37, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19376.37 } ] } ] }, { "description": "Amiodarone HCl Inj 900 MG/18ML (50 MG/ML)", "drug_information": { "unit": 3.0, "type": "ML" }, "code_information": [ { "code": "00143987501", "type": "NDC" }, { "code": "J0282", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0395, "maximum": 6.63, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.63 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.55 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.24 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.55 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.55 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.04 } ] } ] }, { "description": "Eptifibatide IV Soln 75 MG/100ML (0.75 MG/ML)", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "70436002780", "type": "NDC" }, { "code": "J1327", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 34.146, "maximum": 563.68, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 563.68 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 50.92 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 40.74 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 50.92 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 50.92 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.15 } ] } ] }, { "description": "HC ULTRASOUND,PELVIC (NONOBSTETRIC)", "code_information": [ { "code": "76856", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1180.63, "discounted_cash": 342.0, "minimum": 337.51, "maximum": 1070.8314, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 637.96, "10th_percentile": 637.96, "90th_percentile": 690.53, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 340.02, "10th_percentile": 340.02, "90th_percentile": 340.02, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 421.89 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 327.55, "10th_percentile": 309.0, "90th_percentile": 327.55, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 337.51 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 421.89 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 421.89 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 601.65, "10th_percentile": 601.65, "90th_percentile": 601.65, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 742.38, "10th_percentile": 713.78, "90th_percentile": 742.38, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 620.36 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 486.08, "10th_percentile": 486.08, "90th_percentile": 823.68, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 944.5, "10th_percentile": 891.0, "90th_percentile": 944.5, "count": "46" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 302.24, "10th_percentile": 302.24, "90th_percentile": 302.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 816.16, "10th_percentile": 816.16, "90th_percentile": 816.16, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 302.24, "10th_percentile": 285.12, "90th_percentile": 329.67, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 302.24, "10th_percentile": 302.24, "90th_percentile": 302.24, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 302.24, "10th_percentile": 302.24, "90th_percentile": 302.24, "count": "1 through 10" } ] } ] }, { "description": "MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH CC", "code_information": [ { "code": "436", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7397.0, "minimum": 7397.74, "maximum": 13334.52, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13334.52 } ] } ] }, { "description": "Promethazine HCl Oral Soln 6.25 MG/5ML", "drug_information": { "unit": 473.0, "type": "ML" }, "code_information": [ { "code": "70752013812", "type": "NDC" }, { "code": "Q0169", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC (SUP SHELL A4595) TENS SUPPL 2 LEAD PER MONTH", "code_information": [ { "code": "A4595", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 12.95, "maximum": 12.95, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Pembrolizumab IV Soln 100 MG/4ML (25 MG/ML)", "drug_information": { "unit": 4.0, "type": "ML" }, "code_information": [ { "code": "00006302604", "type": "NDC" }, { "code": "J9271", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 186.9525, "maximum": 713.89, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 713.89 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 278.81 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 223.05 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 278.81 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 278.81 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 186.95 } ] } ] }, { "description": "SKIN DEBRIDEMENT WITH MCC", "code_information": [ { "code": "570", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17485.0, "minimum": 17485.57, "maximum": 34672.57, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34672.57 } ] } ] }, { "description": "HC (SUP SHELL A4352) COUDE TIP URINARY CATHETER", "code_information": [ { "code": "A4352", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 9.15, "maximum": 9.15, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 9.15, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC", "code_information": [ { "code": "326", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19951.0, "minimum": 19951.49, "maximum": 58796.36, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 58796.36 } ] } ] }, { "description": "HC (SUP SHELL A4346) CATH INDW FOLEY 3 WAY - A4346 - RU278117", "code_information": [ { "code": "A4346", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 23.72, "maximum": 23.72, "payers_information": [ { "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" } ] } ] }, { "description": "ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC", "code_information": [ { "code": "267", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 2914.0, "minimum": 2914.26, "maximum": 56124.98, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 56124.98 } ] } ] }, { "description": "HC HLA TYPING, A,B,OR C /MULTI", "code_information": [ { "code": "86813", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 685.31, "discounted_cash": 198.0, "minimum": 58.0, "maximum": 621.5762, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 478.59 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 586.44 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 469.15 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 586.44 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 586.44 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 537.69 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 58.0, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC IMHISTOCHEM/CYTCHM PER SEP, EA MULTPLX AB STAIN", "code_information": [ { "code": "88344", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 273.13, "discounted_cash": 79.0, "minimum": 79.2077, "maximum": 273.13, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 273.13 } ] } ] }, { "description": "Phenobarbital Sodium Inj 65 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00641047625", "type": "NDC" }, { "code": "J2560", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 92.736, "maximum": 561.04, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 561.04 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 138.3 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 110.64 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 138.3 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 138.3 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 92.74 } ] } ] }, { "description": "HC M.TUBERCULO, DNA, AMP PROBE", "code_information": [ { "code": "87556", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 491.25, "discounted_cash": 142.0, "minimum": 41.68, "maximum": 445.5638, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 214.99 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 263.43 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 210.75 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 263.43 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 263.43 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 386.39 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 41.68, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC MRI LUMBAR SPINE CONTRAST", "code_information": [ { "code": "72149", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2657.81, "discounted_cash": 770.0, "minimum": 770.7649, "maximum": 2410.6337, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2118.32 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1694.64 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2118.32 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2118.32 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1646.73 } ] } ] }, { "description": "HC X-RAY KNEE BILAT STANDING", "code_information": [ { "code": "73565", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 390.31, "discounted_cash": 113.0, "minimum": 81.52, "maximum": 354.0112, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 83.16 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 101.9 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 81.52 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 101.9 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 101.9 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 270.71 } ] } ] }, { "description": "NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC", "code_information": [ { "code": "068", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4483.0, "minimum": 4483.48, "maximum": 10190.39, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10190.39 } ] } ] }, { "description": "HC MRI LOWER EXTREM JT, W/O CONTRAST", "code_information": [ { "code": "73721", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2882.5, "discounted_cash": 835.0, "minimum": 835.925, "maximum": 2614.4275, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1725.03 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1380.01 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1725.03 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1725.03 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1223.79 } ] } ] }, { "description": "HC X-RAY STERNUM 2+ VW", "code_information": [ { "code": "71120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 615.94, "discounted_cash": 178.0, "minimum": 88.66, "maximum": 558.6576, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 90.44 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 110.83 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 88.66 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 110.83 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 110.83 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 205.83 } ] } ] }, { "description": "OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITHOUT CCMCC", "code_information": [ { "code": "869", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5380.0, "minimum": 5380.18, "maximum": 8602.42, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8602.42 } ] } ] }, { "description": "Ampicillin Sodium For Inj 1 GM", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00781340485", "type": "NDC" }, { "code": "J0290", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.89, "maximum": 16.45, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.45 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2.82 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2.25 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2.82 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2.82 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.89 } ] } ] }, { "description": "Ceftriaxone Sodium For Inj 1 GM", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "60505614800", "type": "NDC" }, { "code": "J0696", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.5435, "maximum": 8.66, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 12.77, "10th_percentile": 12.77, "90th_percentile": 12.77, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.66 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2.3 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.84 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2.3 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2.3 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.54 } ] } ] }, { "description": "HC (SUP SHELL A6453) SELF-ADHER BAND W <3/YD - A6453 - 27100028", "code_information": [ { "code": "A6453", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "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" } ] } ] }, { "description": "HC SMEAR, FLUOR STAIN, W INTERP", "code_information": [ { "code": "87206", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 129.38, "discounted_cash": 37.0, "minimum": 5.39, "maximum": 117.3477, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 44.32 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 54.31 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 43.45 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 54.31 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 54.31 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 49.97 }, { "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" } ] } ] }, { "description": "HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES", "code_information": [ { "code": "97129", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 119.69, "discounted_cash": 34.0, "minimum": 19.37, "maximum": 108.5588, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 19.37, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF VITAMIN E", "code_information": [ { "code": "84446", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 173.44, "discounted_cash": 50.0, "minimum": 14.18, "maximum": 157.3101, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 106.56, "10th_percentile": 106.56, "90th_percentile": 106.56, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 117.02 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 143.39 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 114.71 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 143.39 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 143.39 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 88.38, "10th_percentile": 88.38, "90th_percentile": 88.38, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 111.15, "10th_percentile": 111.15, "90th_percentile": 111.15, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 131.46 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 138.75, "10th_percentile": 138.75, "90th_percentile": 138.75, "count": "16" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 44.4, "10th_percentile": 44.4, "90th_percentile": 44.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 44.4, "10th_percentile": 44.4, "90th_percentile": 44.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 44.4, "10th_percentile": 44.4, "90th_percentile": 47.18, "count": "1 through 10" } ] } ] }, { "description": "SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH MCC", "code_information": [ { "code": "573", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 26900.0, "minimum": 26900.88, "maximum": 77234.32, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 77234.32 } ] } ] }, { "description": "HC US, OB < 14 WKS, SINGLE FETUS", "code_information": [ { "code": "76801", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 967.5, "discounted_cash": 280.0, "minimum": 280.575, "maximum": 877.5225, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 522.86, "10th_percentile": 522.86, "90th_percentile": 594.43, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 400.43 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 320.34 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 400.43 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 400.43 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 493.04, "10th_percentile": 493.04, "90th_percentile": 493.04, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 600.63 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 774.0, "10th_percentile": 730.25, "90th_percentile": 774.0, "count": "16" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 668.91, "10th_percentile": 668.91, "90th_percentile": 668.91, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL L1832) KNEE ORTHOS IMMOBLZR ADJUST PREFAB", "code_information": [ { "code": "L1832", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 912.19, "maximum": 912.19, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 912.19, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC ARTHROGRAM OF SHOULDER", "code_information": [ { "code": "73040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 722.81, "discounted_cash": 209.0, "minimum": 209.6149, "maximum": 722.81, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 316.55 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 387.89 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 310.31 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 387.89 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 387.89 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 722.81 } ] } ] }, { "description": "HC BLASTOMYCES, ANTIBODY", "code_information": [ { "code": "86612", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 231.25, "discounted_cash": 67.0, "minimum": 12.9, "maximum": 209.7438, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 106.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 130.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 104.4 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 130.5 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 130.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 119.59 }, { "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" } ] } ] }, { "description": "HC (SUP SHELL L0482) TLSO RIGID LINED CUSTOM FAB", "code_information": [ { "code": "L0482", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1996.95, "maximum": 1996.95, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1996.95, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC INSULIN ANTIBODIES", "code_information": [ { "code": "86337", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 400.63, "discounted_cash": 116.0, "minimum": 21.41, "maximum": 363.3714, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 176.77 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 216.61 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 173.29 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 216.61 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 216.61 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 198.48 }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 302.25, "10th_percentile": 302.25, "90th_percentile": 302.25, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 102.56, "10th_percentile": 102.56, "90th_percentile": 102.56, "count": "1 through 10" } ] } ] }, { "description": "CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC", "code_information": [ { "code": "837", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22865.0, "minimum": 22865.75, "maximum": 56637.8, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 56637.8 } ] } ] }, { "description": "HC DETECT AGENT, MULT ORGS, DNA, AMP", "code_information": [ { "code": "87801", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 354.38, "discounted_cash": 102.0, "minimum": 70.2, "maximum": 354.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 191.53, "10th_percentile": 191.53, "90th_percentile": 217.73, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 354.38 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 354.38 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 98.32, "10th_percentile": 92.77, "90th_percentile": 98.32, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 354.38 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 354.38 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 354.38 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 170.4, "10th_percentile": 170.4, "90th_percentile": 170.4, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 222.83, "10th_percentile": 222.83, "90th_percentile": 222.83, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 354.38 }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 283.5, "10th_percentile": 267.5, "90th_percentile": 283.5, "count": "46" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 90.72, "10th_percentile": 85.6, "90th_percentile": 90.72, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 257.13, "10th_percentile": 257.13, "90th_percentile": 257.13, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 90.72, "10th_percentile": 90.72, "90th_percentile": 90.72, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 90.72, "10th_percentile": 90.72, "90th_percentile": 90.72, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 90.72, "10th_percentile": 90.72, "90th_percentile": 90.72, "count": "1 through 10" } ] } ] }, { "description": "HC ASSAY OF FOLIC ACID, RBC", "code_information": [ { "code": "82747", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 258.75, "discounted_cash": 75.0, "minimum": 17.65, "maximum": 234.6863, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 129.46 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 158.63 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 126.9 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 158.63 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 158.63 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 163.62 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY SACRUM/COCCYX 2+ VW", "code_information": [ { "code": "72220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 646.88, "discounted_cash": 187.0, "minimum": 81.52, "maximum": 586.7202, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 175.77, "10th_percentile": 175.77, "90th_percentile": 186.3, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 83.16 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 101.9 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 81.52 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 101.9 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 101.9 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 205.83 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 517.5, "10th_percentile": 488.25, "90th_percentile": 517.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 156.24, "10th_percentile": 156.24, "90th_percentile": 166.01, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 469.37, "10th_percentile": 469.37, "90th_percentile": 469.37, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 165.6, "10th_percentile": 165.6, "90th_percentile": 165.6, "count": "1 through 10" } ] } ] }, { "description": "HC TP53 GENE ANALYSIS TARGETED SEQUENCE ANALYSIS", "code_information": [ { "code": "81352", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2250.0, "discounted_cash": 652.0, "minimum": 329.51, "maximum": 2250.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2250.0 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 329.51, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC MPL GENE ANALYSIS SEQUENCE ANALYSIS EXON 10", "code_information": [ { "code": "81339", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1144.06, "discounted_cash": 331.0, "minimum": 185.2, "maximum": 1144.06, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1144.06 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 185.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Octreotide Acetate For IM Inj Kit 20 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00078081881", "type": "NDC" }, { "code": "J2353", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 609.6825, "maximum": 2925.34, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2925.34 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 961.12 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 768.89 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 961.12 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 961.12 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 609.68 } ] } ] }, { "description": "Ceftriaxone Sodium For Inj 250 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "60505615104", "type": "NDC" }, { "code": "J0696", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.5435, "maximum": 8.66, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 12.77, "10th_percentile": 12.77, "90th_percentile": 12.77, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.66 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2.3 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.84 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2.3 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2.3 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.54 } ] } ] }, { "description": "INFLAMMATORY BOWEL DISEASE WITH CC", "code_information": [ { "code": "386", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7397.0, "minimum": 5585.1575, "maximum": 11509.58, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "other", "standard_charge_dollar": 7730.65, "standard_charge_algorithm": "2342.62 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 8705.41, "10th_percentile": 8705.41, "90th_percentile": 8705.41, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11509.58 } ] } ] }, { "description": "HC BLOOD CLOT FACTOR VIII TEST, ONE STAGE", "code_information": [ { "code": "85240", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 164.38, "discounted_cash": 47.0, "minimum": 17.9, "maximum": 164.38, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 147.77 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 164.38 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 144.86 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 164.38 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 164.38 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 164.38 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 131.5, "10th_percentile": 131.5, "90th_percentile": 131.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 42.08, "10th_percentile": 42.08, "90th_percentile": 42.08, "count": "1 through 10" } ] } ] }, { "description": "POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES", "code_information": [ { "code": "776", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5380.0, "minimum": 5380.18, "maximum": 7718.25, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7718.25 } ] } ] }, { "description": "HC HEMOPHILUS INFLUENZA ANTIBDY", "code_information": [ { "code": "86684", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 306.88, "discounted_cash": 88.0, "minimum": 15.84, "maximum": 278.3402, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 80.56 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 98.71 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 78.97 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 98.71 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 98.71 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 146.84 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 15.84, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC", "code_information": [ { "code": "982", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8966.0, "minimum": 8966.96, "maximum": 28983.21, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28983.21 } ] } ] }, { "description": "HC ASSAY OF NUCLEOTIDASE 5'", "code_information": [ { "code": "83915", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 146.25, "discounted_cash": 42.0, "minimum": 11.15, "maximum": 132.6488, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 92.09 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 112.84 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 90.27 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 112.84 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 112.84 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 103.37 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC", "code_information": [ { "code": "234", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18382.0, "minimum": 18382.27, "maximum": 64399.66, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 64399.66 } ] } ] }, { "description": "HC (SUP SHELL C2639) BRACHYTX, NON-STRANDED,I-125", "code_information": [ { "code": "C2639", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 110.5965, "maximum": 110.5965, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 110.6 } ] } ] }, { "description": "WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC", "code_information": [ { "code": "464", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12329.0, "minimum": 12329.57, "maximum": 74580.633, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "other", "standard_charge_dollar": 12884.41, "standard_charge_algorithm": "2342.62 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 82867.37, "10th_percentile": 82867.37, "90th_percentile": 82867.37, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 36719.14 } ] } ] }, { "description": "MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH MCC", "code_information": [ { "code": "754", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11432.0, "minimum": 11432.87, "maximum": 21711.76, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21711.76 } ] } ] }, { "description": "CONCUSSION WITHOUT CCMCC", "code_information": [ { "code": "090", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4259.0, "minimum": 4259.31, "maximum": 9704.69, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9704.69 } ] } ] }, { "description": "HC (SUP SHELL A6455) SELF-ADHER BAND >=5/YD - A6455 - 27100030", "code_information": [ { "code": "A6455", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.99, "maximum": 1.99, "payers_information": [ { "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" } ] } ] }, { "description": "OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITH CCMCC", "code_information": [ { "code": "717", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8070.0, "minimum": 8070.26, "maximum": 22287.07, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22287.07 } ] } ] }, { "description": "TRAUMATIC INJURY WITHOUT MCC", "code_information": [ { "code": "914", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5604.0, "minimum": 5604.35, "maximum": 10439.14, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10439.14 } ] } ] }, { "description": "HC DRUG SCREEN QUANT CAFFEINE", "code_information": [ { "code": "80155", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 484.69, "discounted_cash": 140.0, "minimum": 38.57, "maximum": 439.6138, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 109.1 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 133.69 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 106.95 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 133.69 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 133.69 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 357.56 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 38.57, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC SHIGA-LIKE TOXIN AG EIA", "code_information": [ { "code": "87427", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 38.75, "discounted_cash": 11.0, "minimum": 11.2375, "maximum": 38.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 22.67, "10th_percentile": 22.67, "90th_percentile": 22.67, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 38.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 38.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 10.15, "10th_percentile": 10.15, "90th_percentile": 10.15, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 38.75 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 38.75 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 38.75 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 23.43, "10th_percentile": 23.43, "90th_percentile": 23.43, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.75 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 29.25, "10th_percentile": 29.25, "90th_percentile": 29.25, "count": "1 through 10" }, { "payer_name": "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 31.0, "10th_percentile": 29.25, "90th_percentile": 31.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 11.98, "10th_percentile": 9.36, "90th_percentile": 11.98, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 9.36, "10th_percentile": 9.36, "90th_percentile": 9.92, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 9.95, "10th_percentile": 9.92, "90th_percentile": 11.98, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 9.92, "10th_percentile": 9.92, "90th_percentile": 9.92, "count": "1 through 10" } ] } ] }, { "description": "HC CT SCAN,PELVIS,W/O CONTRAST", "code_information": [ { "code": "72192", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2225.0, "discounted_cash": 645.0, "minimum": 645.25, "maximum": 2018.075, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 537.36, "10th_percentile": 537.36, "90th_percentile": 570.95, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 537.36, "10th_percentile": 537.36, "90th_percentile": 537.36, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 569.6, "10th_percentile": 569.6, "90th_percentile": 621.32, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 569.6, "10th_percentile": 569.6, "90th_percentile": 570.95, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 963.52 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 617.3, "10th_percentile": 617.3, "90th_percentile": 617.3, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 770.82 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 963.52 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 963.52 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 1399.08, "10th_percentile": 1399.08, "90th_percentile": 1399.08, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 721.85 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1780.0, "10th_percentile": 1780.0, "90th_percentile": 1780.0, "count": "1 through 10" } ] } ] }, { "description": "HC INTRAOPERATIVE CYTO PATH CONSULT, ADD SITES", "code_information": [ { "code": "88334", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 124.38, "discounted_cash": 36.0, "minimum": 36.0702, "maximum": 124.38, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 124.38 } ] } ] }, { "description": "HC (SUP SHELL L3906) WHO W/O JOINTS CF", "code_information": [ { "code": "L3906", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 527.5, "maximum": 527.5, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 527.5, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF PHENYTOIN, FREE", "code_information": [ { "code": "80186", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 64.06, "discounted_cash": 18.0, "minimum": 13.76, "maximum": 64.06, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 64.06 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 64.06 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 64.06 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 64.06 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 64.06 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 64.06 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "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": 97.0, "minimum": 18.52, "maximum": 303.5638, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 93.67 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 114.78 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 91.82 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 114.78 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 114.78 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 171.69 }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 267.75, "10th_percentile": 267.75, "90th_percentile": 267.75, "count": "1 through 10" } ] } ] }, { "description": "HC HEART FIRST PASS SINGLE,PLANAR", "code_information": [ { "code": "78481", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 419.38, "discounted_cash": 121.0, "minimum": 121.6202, "maximum": 419.38, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 419.38 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 419.38 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 419.38 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 419.38 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 419.38 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 419.38 } ] } ] }, { "description": "HC RADIOLOGIC SMALL INTESTINE FOLLOW-THROUGH STUDY", "code_information": [ { "code": "74248", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1179.69, "discounted_cash": 342.0, "minimum": 342.1101, "maximum": 1069.9788, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 420.13 } ] } ] }, { "description": "HC BLOOD COUNT AUTOMATED DIFFERENTIAL WBC COUNT", "code_information": [ { "code": "85004", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 38.44, "discounted_cash": 11.0, "minimum": 6.47, "maximum": 38.44, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 38.44 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 38.44 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 38.44 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 38.44 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 38.44 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.44 }, { "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" } ] } ] }, { "description": "HC TOTAL CORTISOL", "code_information": [ { "code": "82533", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 223.44, "discounted_cash": 64.0, "minimum": 16.3, "maximum": 202.6601, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 64.35, "10th_percentile": 64.35, "90th_percentile": 64.35, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 134.6 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 164.93 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 62.0, "10th_percentile": 62.0, "90th_percentile": 62.0, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 131.95 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 164.93 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 164.93 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 113.86, "10th_percentile": 113.86, "90th_percentile": 113.86, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 140.5, "10th_percentile": 140.5, "90th_percentile": 140.5, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 151.11 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 178.75, "10th_percentile": 178.75, "90th_percentile": 178.75, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 178.75, "10th_percentile": 178.75, "90th_percentile": 178.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 57.2, "10th_percentile": 16.3, "90th_percentile": 60.78, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 162.13, "10th_percentile": 162.13, "90th_percentile": 162.13, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 57.2, "10th_percentile": 57.2, "90th_percentile": 66.14, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 57.2, "10th_percentile": 57.2, "90th_percentile": 57.2, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 57.2, "10th_percentile": 57.2, "90th_percentile": 57.2, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL A6220) GAUZE >16 <=48 SQ IN W/BORDR - A6220 - 27200124", "code_information": [ { "code": "A6220", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 3.69, "maximum": 3.69, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3.69, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF TROPONIN, QUANT", "code_information": [ { "code": "84484", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 248.13, "discounted_cash": 71.0, "minimum": 12.47, "maximum": 225.0539, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 142.13, "10th_percentile": 142.13, "90th_percentile": 142.13, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 71.46, "10th_percentile": 71.46, "90th_percentile": 142.92, "count": "27" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 81.24 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 99.54 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 68.84, "10th_percentile": 68.84, "90th_percentile": 137.68, "count": "47" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 79.63 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 99.54 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 99.54 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 162.77, "10th_percentile": 159.0, "90th_percentile": 318.0, "count": "12" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 159.02, "10th_percentile": 156.02, "90th_percentile": 312.04, "count": "19" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 115.6 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 198.5, "10th_percentile": 170.81, "90th_percentile": 595.5, "count": "15" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 198.5, "10th_percentile": 198.5, "90th_percentile": 397.0, "count": "258" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 63.52, "10th_percentile": 63.52, "90th_percentile": 127.04, "count": "81" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 181.83, "10th_percentile": 180.04, "90th_percentile": 360.08, "count": "21" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 63.52, "10th_percentile": 63.52, "90th_percentile": 127.04, "count": "113" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 63.52, "10th_percentile": 63.52, "90th_percentile": 127.04, "count": "88" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 63.52, "10th_percentile": 63.52, "90th_percentile": 134.98, "count": "47" } ] } ] }, { "description": "HC X-RAY RIBS, CHEST 4+ VW", "code_information": [ { "code": "71111", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 827.81, "discounted_cash": 240.0, "minimum": 141.59, "maximum": 750.8237, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 144.44 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 176.99 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 229.67, "10th_percentile": 229.67, "90th_percentile": 229.67, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 141.59 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 176.99 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 176.99 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 315.78 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 211.92, "10th_percentile": 211.92, "90th_percentile": 211.92, "count": "1 through 10" } ] } ] }, { "description": "HC TISSUE EXAM BY KOH", "code_information": [ { "code": "87220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 115.0, "discounted_cash": 33.0, "minimum": 4.27, "maximum": 104.305, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 33.58 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 41.15 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 32.92 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 41.15 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 41.15 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.59 }, { "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": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 292.17, "10th_percentile": 292.17, "90th_percentile": 292.17, "count": "1 through 10" } ] } ] }, { "description": "HC DEXA,BONE DENSITY,VERTEB FRACT", "code_information": [ { "code": "77085", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 564.38, "discounted_cash": 163.0, "minimum": 163.6702, "maximum": 511.8927, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 167.78 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 205.59 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 164.47 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 205.59 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 205.59 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 332.72 } ] } ] }, { "description": "HC ASSAY OF FOR HVA", "code_information": [ { "code": "83150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 574.38, "discounted_cash": 166.0, "minimum": 22.41, "maximum": 520.9627, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 195.69 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 156.55 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 195.69 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 195.69 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 207.75 }, { "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" } ] } ] }, { "description": "HC (SUP SHELL A6203) COMPOSITE DRSG <= 16 SQ IN - A6203 - RU272041", "code_information": [ { "code": "A6203", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 4.8, "maximum": 4.8, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC", "code_information": [ { "code": "057", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8518.0, "minimum": 8518.61, "maximum": 18135.1995, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "other", "standard_charge_dollar": 8901.96, "standard_charge_algorithm": "2342.62 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 4912.78, "10th_percentile": 4912.78, "90th_percentile": 4912.78, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 8518.61, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 8116.68, "10th_percentile": 8116.68, "90th_percentile": 19499.2, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15273.8 } ] } ] }, { "description": "HC MOLECULAR PATHOLOGY PROCEDURE LEVEL 2", "code_information": [ { "code": "81401", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1861.88, "discounted_cash": 539.0, "minimum": 137.0, "maximum": 1688.7252, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 259.19 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 317.6 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 254.08 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 317.6 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 317.6 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1270.06 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 137.0, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L3917) METACARP FX ORTHOSIS PRE CST", "code_information": [ { "code": "L3917", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 115.37, "maximum": 115.37, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 115.37, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC PLETHYSMOGRAPHY LUNG VOLUMES W/WO AIRWAY RESIST", "code_information": [ { "code": "94726", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1475.31, "discounted_cash": 427.0, "minimum": 427.8399, "maximum": 1338.1062, "payers_information": [ { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 167.43, "10th_percentile": 167.43, "90th_percentile": 167.43, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 219.5, "10th_percentile": 219.5, "90th_percentile": 219.5, "count": "1 through 10" } ] } ] }, { "description": "CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC", "code_information": [ { "code": "024", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8294.0, "minimum": 8294.44, "maximum": 46117.31, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 46117.31 } ] } ] }, { "description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC", "code_information": [ { "code": "475", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13226.0, "minimum": 13226.27, "maximum": 26828.18, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26828.18 } ] } ] }, { "description": "DIABETES WITH MCC", "code_information": [ { "code": "637", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8742.0, "minimum": 8742.79, "maximum": 20071.9192, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "other", "standard_charge_dollar": 8742.79, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 9840.0, "10th_percentile": 9840.0, "90th_percentile": 14760.0, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16937.23 } ] } ] }, { "description": "HC (SUP SHELL A6454) SELF-ADHER BAND W>=3 <5/YD - A6454 - 27100029", "code_information": [ { "code": "A6454", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.12, "maximum": 1.12, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.12, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC", "code_information": [ { "code": "657", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5604.0, "minimum": 5604.35, "maximum": 21573.83, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21573.83 } ] } ] }, { "description": "MINOR SKIN DISORDERS WITH MCC", "code_information": [ { "code": "606", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10087.0, "minimum": 10087.83, "maximum": 17839.08, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17839.08 } ] } ] }, { "description": "Calcitonin (Salmon) Inj 200 Unit/ML", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "24201040002", "type": "NDC" }, { "code": "J0630", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 3598.5915, "maximum": 38304.95, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 38304.95 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5366.81 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4293.41 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 5366.81 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 5366.81 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3598.59 } ] } ] }, { "description": "HC ADRENAL IMAGING CORTEX &/MEDULLA", "code_information": [ { "code": "78075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1501.88, "discounted_cash": 435.0, "minimum": 435.5452, "maximum": 1501.88, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1467.57 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1501.88 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1438.62 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1501.88 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1501.88 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1501.88 } ] } ] }, { "description": "HC (SUP SHELL A4333) URINARY CATH ANCHOR DEVICE", "code_information": [ { "code": "A4333", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 3.16, "maximum": 3.16, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3.16, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L3650) SO 8 ABD RESTRAINT PRE OTS", "code_information": [ { "code": "L3650", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 82.65, "maximum": 82.65, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 82.65, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "PANCREAS, LIVER AND SHUNT PROCEDURES WITH MCC", "code_information": [ { "code": "405", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18830.0, "minimum": 18830.62, "maximum": 64491.62, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 64491.62 } ] } ] }, { "description": "HC CARDIAC MRI MORPHOLOGY & FUNCTION W/O CONTRAST", "code_information": [ { "code": "75557", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 978.13, "discounted_cash": 283.0, "minimum": 283.6577, "maximum": 978.13, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 978.13 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 978.13 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 978.13 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 978.13 }, { "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": 978.13 } ] } ] }, { "description": "HC TRYPSIN FECES QUAN 24-HR", "code_information": [ { "code": "84490", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 69.38, "discounted_cash": 20.0, "minimum": 9.93, "maximum": 69.38, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 62.81 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 69.38 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 61.57 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 69.38 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 69.38 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 69.38 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 9.93, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC F2 GENE ANALYSIS 20210G >A VARIANT", "code_information": [ { "code": "81240", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 184.06, "discounted_cash": 53.0, "minimum": 53.3774, "maximum": 184.06, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 184.06 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 184.06 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 184.06 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 184.06 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 184.06 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 184.06 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 65.69, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC CULTURE TYPING, SEROLOGIC", "code_information": [ { "code": "87147", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 38.75, "discounted_cash": 11.0, "minimum": 5.18, "maximum": 38.75, "payers_information": [ { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 7.21, "10th_percentile": 7.21, "90th_percentile": 7.21, "count": "1 through 10" }, { "payer_name": "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 26.0, "10th_percentile": 24.5, "90th_percentile": 31.0, "count": "93" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 9.92, "10th_percentile": 5.18, "90th_percentile": 19.89, "count": "20" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 23.58, "10th_percentile": 20.78, "90th_percentile": 56.23, "count": "12" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 9.36, "10th_percentile": 7.84, "90th_percentile": 19.84, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 8.33, "10th_percentile": 8.32, "90th_percentile": 39.78, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 9.92, "10th_percentile": 8.32, "90th_percentile": 9.92, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 17.54, "10th_percentile": 17.54, "90th_percentile": 17.54, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 11.16, "10th_percentile": 11.16, "90th_percentile": 11.16, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 38.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 38.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 10.15, "10th_percentile": 8.5, "90th_percentile": 21.5, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 38.75 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 38.75 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 38.75 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 20.09, "10th_percentile": 15.61, "90th_percentile": 23.98, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 19.63, "10th_percentile": 19.63, "90th_percentile": 23.43, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.75 } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CCMCC", "code_information": [ { "code": "221", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6501.0, "minimum": 6501.05, "maximum": 59418.82, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 59418.82 } ] } ] }, { "description": "HC CT SCAN MAXILLOFACIAL AREA W CONTRAST", "code_information": [ { "code": "70487", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1978.44, "discounted_cash": 573.0, "minimum": 573.7476, "maximum": 1794.4451, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 569.79, "10th_percentile": 569.79, "90th_percentile": 569.79, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1351.41 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1081.12 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1351.41 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1351.41 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 874.14 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1582.75, "10th_percentile": 1582.75, "90th_percentile": 1582.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 506.48, "10th_percentile": 506.48, "90th_percentile": 506.48, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 409.76, "10th_percentile": 409.76, "90th_percentile": 409.76, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 506.48, "10th_percentile": 506.48, "90th_percentile": 506.48, "count": "1 through 10" } ] } ] }, { "description": "HC TOXOPLASMA", "code_information": [ { "code": "86777", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 138.75, "discounted_cash": 40.0, "minimum": 14.39, "maximum": 138.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 118.83 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 138.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 116.48 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 138.75 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 138.75 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 66.73, "10th_percentile": 66.73, "90th_percentile": 66.73, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 133.4 }, { "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" } ] } ] }, { "description": "HC (SUP SHELL L3982) UPPER EXT FX ORTHOSIS RAD/UL", "code_information": [ { "code": "L3982", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 488.53, "maximum": 488.53, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 488.53, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF CALCIUM IN URINE", "code_information": [ { "code": "82340", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 110.94, "discounted_cash": 32.0, "minimum": 6.03, "maximum": 100.6226, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 47.88 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 58.67 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 46.94 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 58.67 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 58.67 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 55.9 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 6.03, "10th_percentile": 6.03, "90th_percentile": 6.03, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 28.4, "10th_percentile": 28.4, "90th_percentile": 28.4, "count": "1 through 10" } ] } ] }, { "description": "D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CCMCC", "code_information": [ { "code": "744", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10312.0, "minimum": 10312.0, "maximum": 24156.8, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24156.8 } ] } ] }, { "description": "KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CCMCC", "code_information": [ { "code": "487", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7846.0, "minimum": 7846.09, "maximum": 18463.9, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18463.9 } ] } ] }, { "description": "HC (SUP SHELL A4413) 2 PC DRAINABLE OST POUCH", "code_information": [ { "code": "A4413", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 7.85, "maximum": 7.85, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7.85, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L8630) METACARPOPHALANGEAL IMPLANT", "code_information": [ { "code": "L8630", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 549.94, "maximum": 549.94, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 549.94, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC", "code_information": [ { "code": "461", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13226.0, "minimum": 13226.27, "maximum": 65110.54, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 65110.54 } ] } ] }, { "description": "KCl 20 MEQ/L (0.15%) in NaCl 0.9% Inj", "drug_information": { "unit": 1000.0, "type": "ML" }, "code_information": [ { "code": "00264786500", "type": "NDC" }, { "code": "J3480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.76, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 62.35, "10th_percentile": 62.35, "90th_percentile": 62.35, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.76 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC CT SCAN CERV SP COMBO", "code_information": [ { "code": "72127", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1910.0, "discounted_cash": 553.0, "minimum": 553.9, "maximum": 1732.37, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1691.07 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1352.85 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1691.07 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1691.07 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1212.52 } ] } ] }, { "description": "HC DIGITAL BREAST TOMOSYNTHESIS BILAT - G0279 - 40100011", "code_information": [ { "code": "G0279", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 796.88, "minimum": 11.68, "maximum": 722.7702, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 81.75 }, { "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" } ] } ] }, { "description": "Rabies Immune Globulin (Human) Inj 1500 Unt/5ML (300 Unt/ML)", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "13533031801", "type": "NDC" }, { "code": "90375", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 913.2165, "maximum": 4347.95, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4347.95 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1361.94 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1089.54 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1361.94 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1361.94 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 913.22 } ] } ] }, { "description": "HC (SUP SHELL A6235) HYDROCOLLD DRG >16<=48 W/O B - A6235 - 27200132", "code_information": [ { "code": "A6235", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 23.97, "maximum": 23.97, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 23.97, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4410) OST SKN BARR EXTND >4 SQ", "code_information": [ { "code": "A4410", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 12.88, "maximum": 12.88, "payers_information": [ { "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" } ] } ] }, { "description": "HC ASSAY OF BLOOD CHLORIDE", "code_information": [ { "code": "82435", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 47.19, "discounted_cash": 13.0, "minimum": 4.6, "maximum": 46.41, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 37.88 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 46.41 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 37.13 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 46.41 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 46.41 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 42.64 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 12.08, "10th_percentile": 12.08, "90th_percentile": 12.08, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL A4398) OSTOMY IRRIGATION BAG", "code_information": [ { "code": "A4398", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 19.35, "maximum": 131.02, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 131.02 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 104.82 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 131.02 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 131.02 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4430) OST URINE PCH W B/BLTIN CONV", "code_information": [ { "code": "A4430", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 12.14, "maximum": 12.14, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.14, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC X-RAYS, BONE SURVEY COMPLETE", "code_information": [ { "code": "77075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 787.81, "discounted_cash": 228.0, "minimum": 228.4649, "maximum": 714.5437, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 290.3 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 355.72 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 284.58 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 355.72 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 355.72 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 623.16 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 201.68, "10th_percentile": 201.68, "90th_percentile": 201.68, "count": "1 through 10" } ] } ] }, { "description": "HC ANTIBODY JOHN CUNNINGHAM VIRUS", "code_information": [ { "code": "86711", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2140.94, "discounted_cash": 620.0, "minimum": 16.89, "maximum": 1941.8326, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 111.87 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 137.09 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 109.67 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 137.09 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 137.09 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 156.58 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.89, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L8000) MASTECTOMY BRA", "code_information": [ { "code": "L8000", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 45.52, "maximum": 45.52, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 45.52, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Ondansetron HCl Inj 4 MG/2ML (2 MG/ML)", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "60505613000", "type": "NDC" }, { "code": "J2405", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 12.77, "10th_percentile": 12.77, "90th_percentile": 13.54, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.19 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "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": 90.0, "median_amount": 6.25, "10th_percentile": 6.25, "90th_percentile": 6.25, "count": "1 through 10" } ] } ] }, { "description": "HC MRI, FACE, NECK", "code_information": [ { "code": "70540", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2005.94, "discounted_cash": 581.0, "minimum": 581.7226, "maximum": 1819.3876, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1725.03 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1380.01 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1725.03 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1725.03 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1435.29 } ] } ] }, { "description": "PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE", "code_information": [ { "code": "175", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8518.0, "minimum": 8518.61, "maximum": 16193.34, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16193.34 } ] } ] }, { "description": "HC CARDIOLIPIN ANTIBODY", "code_information": [ { "code": "86147", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 422.5, "discounted_cash": 122.0, "minimum": 25.45, "maximum": 383.2075, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 113.46 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 139.02 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 234.44, "10th_percentile": 234.44, "90th_percentile": 234.44, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 111.22 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 139.02 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 139.02 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 235.93 }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 956.25, "10th_percentile": 318.75, "90th_percentile": 1275.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 108.16, "10th_percentile": 108.16, "90th_percentile": 108.16, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL L1831) KNEE ORTH POS LOCKING JOINT", "code_information": [ { "code": "L1831", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 353.04, "maximum": 353.04, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 353.04, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF PROCAINAMIDE W METABOLITES", "code_information": [ { "code": "80192", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 210.94, "discounted_cash": 61.0, "minimum": 16.75, "maximum": 191.3226, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 138.27 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 169.43 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 135.55 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 169.43 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 169.43 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 155.28 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.75, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY FOR BILE DUCT ENDOSCOPY", "code_information": [ { "code": "74328", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1932.19, "discounted_cash": 560.0, "minimum": 448.337, "maximum": 1752.4963, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 517.87 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 634.57 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 507.65 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 634.57 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 634.57 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 448.34 } ] } ] }, { "description": "ATHEROSCLEROSIS WITHOUT MCC", "code_information": [ { "code": "303", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4035.0, "minimum": 4035.13, "maximum": 7936.34, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7936.34 } ] } ] }, { "description": "HC BLOOD CLOT FACTOR X TEST", "code_information": [ { "code": "85260", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 410.94, "discounted_cash": 119.0, "minimum": 17.9, "maximum": 372.7226, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 147.77 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 181.07 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 144.86 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 181.07 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 181.07 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 165.94 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC BLOOD GASES: PH, PO2 & PCO2 W O2 SATU", "code_information": [ { "code": "82805", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 428.44, "discounted_cash": 124.0, "minimum": 78.77, "maximum": 428.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 245.41, "10th_percentile": 245.41, "90th_percentile": 245.41, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 123.39, "10th_percentile": 123.39, "90th_percentile": 123.39, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 234.21 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 286.99 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 118.87, "10th_percentile": 118.87, "90th_percentile": 118.87, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 229.59 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 286.99 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 286.99 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 281.05, "10th_percentile": 274.54, "90th_percentile": 281.06, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 428.44 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 342.75, "10th_percentile": 342.75, "90th_percentile": 342.75, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 342.75, "10th_percentile": 342.75, "90th_percentile": 685.5, "count": "69" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 109.68, "10th_percentile": 109.68, "90th_percentile": 116.54, "count": "23" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 310.87, "10th_percentile": 310.87, "90th_percentile": 310.87, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 109.68, "10th_percentile": 109.68, "90th_percentile": 109.68, "count": "22" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 109.68, "10th_percentile": 109.68, "90th_percentile": 116.54, "count": "20" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 109.68, "10th_percentile": 109.68, "90th_percentile": 116.54, "count": "13" } ] } ] }, { "description": "EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CCMCC", "code_information": [ { "code": "983", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4483.0, "minimum": 4483.48, "maximum": 20206.31, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20206.31 } ] } ] }, { "description": "HC X-RAY NOSE-RECTUM CHILD F.B.", "code_information": [ { "code": "76010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 436.88, "discounted_cash": 126.0, "minimum": 72.92, "maximum": 396.2502, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 74.39 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 91.15 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 72.92 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 91.15 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 91.15 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 177.63 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 329.75, "10th_percentile": 329.75, "90th_percentile": 329.75, "count": "1 through 10" } ] } ] }, { "description": "Pantoprazole Sodium For IV Soln 40 MG (Base Equiv)", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "71288060010", "type": "NDC" }, { "code": "J2470", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 14.616, "maximum": 21.8, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.8 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 17.44 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 21.8 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 21.8 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.62 } ] } ] }, { "description": "SPINAL PROCEDURES WITH MCC", "code_information": [ { "code": "028", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21296.0, "minimum": 21296.53, "maximum": 70831.73, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 70831.73 } ] } ] }, { "description": "HC MYCOPHENOLATE ASSAY", "code_information": [ { "code": "80180", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 232.5, "discounted_cash": 67.0, "minimum": 18.05, "maximum": 210.8775, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 170.61 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 136.49 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 170.61 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 170.61 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 167.33 }, { "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": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 139.24 } ] } ] }, { "description": "LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH CC", "code_information": [ { "code": "496", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6276.0, "minimum": 6276.87, "maximum": 21266.14, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21266.14 } ] } ] }, { "description": "HC CRYPTOCOCCUS NEOFORMANS AG, EIA", "code_information": [ { "code": "87327", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 808.44, "discounted_cash": 234.0, "minimum": 13.42, "maximum": 733.2551, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 94.58 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 115.89 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 92.71 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 115.89 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 115.89 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 124.41 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.42, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT CCMCC", "code_information": [ { "code": "566", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5380.0, "minimum": 5380.18, "maximum": 8833.48, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8833.48 } ] } ] }, { "description": "MAJOR MALE PELVIC PROCEDURES WITH CCMCC", "code_information": [ { "code": "707", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4931.0, "minimum": 4931.83, "maximum": 23581.5, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23581.5 } ] } ] }, { "description": "HC ASSAY OF URINE SODIUM", "code_information": [ { "code": "84300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 63.13, "discounted_cash": 18.0, "minimum": 5.06, "maximum": 57.2589, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 40.14 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 49.18 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 17.51, "10th_percentile": 17.51, "90th_percentile": 17.51, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 39.35 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 49.18 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 49.18 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 46.91 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 50.5, "10th_percentile": 50.5, "90th_percentile": 50.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 16.16, "10th_percentile": 16.16, "90th_percentile": 16.16, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 16.16, "10th_percentile": 16.16, "90th_percentile": 16.16, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 16.16, "10th_percentile": 16.16, "90th_percentile": 16.16, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 16.16, "10th_percentile": 16.16, "90th_percentile": 16.16, "count": "1 through 10" } ] } ] }, { "description": "Octreotide Acetate Inj 100 MCG/ML (0.1 MG/ML)", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "63323037601", "type": "NDC" }, { "code": "J2354", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.8585, "maximum": 13.69, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.69 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2.77 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2.22 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2.77 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2.77 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.86 } ] } ] }, { "description": "Potassium Chloride Inj 20 mEq/50ML", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "00990707714", "type": "NDC" }, { "code": "J3480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.76, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 62.35, "10th_percentile": 62.35, "90th_percentile": 62.35, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.76 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC GENOTYPE DNA HIV REVERSE TRANSCRIPTASE", "code_information": [ { "code": "87901", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1551.25, "discounted_cash": 449.0, "minimum": 257.45, "maximum": 1551.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 679.05 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 832.07 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 665.66 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 832.07 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 832.07 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1551.25 }, { "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" } ] } ] }, { "description": "HC GTT-ADDED SAMPLES", "code_information": [ { "code": "82952", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 69.38, "discounted_cash": 20.0, "minimum": 3.92, "maximum": 62.9277, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 39.74, "10th_percentile": 39.74, "90th_percentile": 39.74, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 23.74 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 29.09 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 23.27 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 29.09 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 29.09 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.34 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 55.5, "10th_percentile": 55.5, "90th_percentile": 55.5, "count": "1 through 10" } ] } ] }, { "description": "OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "833", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3810.0, "minimum": 3810.96, "maximum": 6164.46, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6164.46 } ] } ] }, { "description": "HC (SUP SHELL Q4239) AMNIO-MAXX OR LITE PER SQ CM", "code_information": [ { "code": "Q4239", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 7402.248, "maximum": 11039.45, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 11039.45 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8831.47 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 11039.45 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 11039.45 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7402.25 } ] } ] }, { "description": "HC (SUP SHELL A4629) TRACHEOSTOMY CARE KIT - A4629 - 27200094", "code_information": [ { "code": "A4629", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 6.63, "maximum": 6.63, "payers_information": [ { "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" } ] } ] }, { "description": "THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC", "code_information": [ { "code": "626", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4259.0, "minimum": 4259.31, "maximum": 17676.4, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17676.4 } ] } ] }, { "description": "HC X-RAY,SMALL BOWEL,W/MULT SERIAL FILMS", "code_information": [ { "code": "74250", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1262.5, "discounted_cash": 366.0, "minimum": 301.74, "maximum": 1145.0875, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 363.6, "10th_percentile": 363.6, "90th_percentile": 363.6, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 307.82 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 377.18 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 301.74 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 377.18 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 377.18 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 710.58 } ] } ] }, { "description": "HC (SUP SHELL Q4140) BIODFENCE 1CM", "code_information": [ { "code": "Q4140", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 532.098, "maximum": 2412.84, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2412.84 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 793.55 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 634.84 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 793.55 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 793.55 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 532.1 } ] } ] }, { "description": "HC ASSAY OTHER FLUID CHLORIDES", "code_information": [ { "code": "82438", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 94.06, "discounted_cash": 27.0, "minimum": 5.0, "maximum": 85.3124, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 40.36 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 49.46 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 39.57 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 49.46 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 49.46 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 46.35 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.0, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC GLYCATED PROTEIN", "code_information": [ { "code": "82985", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 192.81, "discounted_cash": 55.0, "minimum": 16.76, "maximum": 174.8787, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 124.42 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 152.46 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 121.97 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 152.46 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 152.46 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 155.37 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 57.07, "10th_percentile": 57.07, "90th_percentile": 57.07, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 49.36, "10th_percentile": 49.36, "90th_percentile": 49.36, "count": "1 through 10" } ] } ] }, { "description": "Famotidine Inj 20 MG/2ML", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "63323073911", "type": "NDC" }, { "code": "J1308", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 12.77, "10th_percentile": 12.77, "90th_percentile": 13.54, "count": "20" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "NERVOUS SYSTEM NEOPLASMS WITH MCC", "code_information": [ { "code": "054", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8966.0, "minimum": 8966.96, "maximum": 18000.59, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18000.59 } ] } ] }, { "description": "HC (SUP SHELL A6446) CONFORM BAND S W>=3 <5/YD - A6446 - 27200157", "code_information": [ { "code": "A6446", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "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" } ] } ] }, { "description": "HC CHORIONIC GONADOTROPIN, QUANT", "code_information": [ { "code": "84702", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 208.44, "discounted_cash": 60.0, "minimum": 15.05, "maximum": 189.0551, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 119.39, "10th_percentile": 119.39, "90th_percentile": 119.39, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 124.26 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 152.26 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 121.8 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 152.26 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 152.26 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 136.74, "10th_percentile": 136.74, "90th_percentile": 136.74, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 133.58, "10th_percentile": 133.58, "90th_percentile": 133.58, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 139.52 }, { "payer_name": "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 166.75, "10th_percentile": 166.75, "90th_percentile": 166.75, "count": "121" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 152.74, "10th_percentile": 152.74, "90th_percentile": 152.74, "count": "1 through 10" } ] } ] }, { "description": "HC NM BONE IMAGING, WHOLE BODY", "code_information": [ { "code": "78306", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1461.88, "discounted_cash": 423.0, "minimum": 423.9452, "maximum": 1461.88, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 812.58 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 995.69 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 796.55 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 995.69 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 995.69 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1461.88 } ] } ] }, { "description": "HC X-RAY ABDOMEN 2 VW", "code_information": [ { "code": "74019", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 769.06, "discounted_cash": 223.0, "minimum": 87.07, "maximum": 697.5374, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 472.51, "10th_percentile": 472.51, "90th_percentile": 472.51, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 208.98, "10th_percentile": 208.98, "90th_percentile": 221.49, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 88.83 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 108.84 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 87.07 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 108.84 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 108.84 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 219.97 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 196.88, "10th_percentile": 196.88, "90th_percentile": 196.88, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 615.25, "10th_percentile": 615.25, "90th_percentile": 615.25, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 185.76, "10th_percentile": 39.38, "90th_percentile": 214.79, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 196.88, "10th_percentile": 196.88, "90th_percentile": 197.37, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 197.37, "10th_percentile": 197.37, "90th_percentile": 197.37, "count": "1 through 10" } ] } ] }, { "description": "HC MURAMIDASE", "code_information": [ { "code": "85549", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 56.25, "discounted_cash": 16.0, "minimum": 16.3125, "maximum": 56.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 56.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 56.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 56.25 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 56.25 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 56.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 56.25 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18.75, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4559) COUPLING GEL OR PASTE", "code_information": [ { "code": "A4559", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "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" } ] } ] }, { "description": "HC IMMUNOFIX E-PHORESIS, SERUM", "code_information": [ { "code": "86334", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 350.31, "discounted_cash": 101.0, "minimum": 22.34, "maximum": 317.7312, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 73.98, "10th_percentile": 60.03, "90th_percentile": 78.39, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 184.4 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 225.96 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 75.52, "10th_percentile": 75.52, "90th_percentile": 75.52, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 180.77 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 225.96 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 225.96 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 207.1 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 69.68, "10th_percentile": 69.68, "90th_percentile": 69.68, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 22.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 205.5, "10th_percentile": 205.5, "90th_percentile": 217.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 65.76, "10th_percentile": 22.34, "90th_percentile": 69.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 76.04, "10th_percentile": 76.04, "90th_percentile": 76.04, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 65.76, "10th_percentile": 53.36, "90th_percentile": 76.04, "count": "22" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 69.68, "10th_percentile": 53.36, "90th_percentile": 69.87, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 53.36, "10th_percentile": 53.36, "90th_percentile": 53.36, "count": "1 through 10" } ] } ] }, { "description": "HC CHYLMD TRACH, DNA, AMP PROBE", "code_information": [ { "code": "87491", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 111.56, "discounted_cash": 32.0, "minimum": 32.3524, "maximum": 111.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 60.32, "10th_percentile": 60.32, "90th_percentile": 68.54, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 32.13, "10th_percentile": 32.13, "90th_percentile": 32.13, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 111.56 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 111.56 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 111.56 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 111.56 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 111.56 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 53.67, "10th_percentile": 53.67, "90th_percentile": 56.85, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 70.15, "10th_percentile": 67.49, "90th_percentile": 70.15, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 111.56 }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 89.25, "10th_percentile": 84.25, "90th_percentile": 89.25, "count": "180" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 26.96, "10th_percentile": 26.96, "90th_percentile": 26.96, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 80.95, "10th_percentile": 77.17, "90th_percentile": 80.95, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 28.56, "10th_percentile": 28.56, "90th_percentile": 31.17, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 28.56, "10th_percentile": 28.56, "90th_percentile": 28.56, "count": "1 through 10" } ] } ] }, { "description": "APPENDIX PROCEDURES WITH CC", "code_information": [ { "code": "398", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6501.0, "minimum": 6501.05, "maximum": 17843.8, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17843.8 } ] } ] }, { "description": "Chlorpromazine HCl Tab 25 MG", "drug_information": { "unit": 100.0, "type": "EA" }, "code_information": [ { "code": "00832601800", "type": "NDC" }, { "code": "Q0161", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.134, "maximum": 34.08, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 34.08 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.69 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.35 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.69 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.69 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.13 } ] } ] }, { "description": "HC ST BEHAVI QUALT ANALYSIS VOICE & RESONANCE, 15 MIN", "code_information": [ { "code": "92524", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 453.13, "discounted_cash": 131.0, "minimum": 95.0, "maximum": 410.9889, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 105.62, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC US FETAL HEART DOPPLER", "code_information": [ { "code": "76827", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 818.44, "discounted_cash": 237.0, "minimum": 173.04, "maximum": 742.3251, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 176.52 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 216.3 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 173.04 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 216.3 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 216.3 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 360.92 } ] } ] }, { "description": "CAROTID ARTERY STENT PROCEDURES WITH MCC", "code_information": [ { "code": "034", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10536.0, "minimum": 10536.18, "maximum": 45631.6, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 45631.6 } ] } ] }, { "description": "HC MRA SPINAL CANAL W CONTRAST - C8931 - 61800010", "code_information": [ { "code": "C8931", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2284.38, "minimum": 662.4702, "maximum": 2071.9327, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 } ] } ] }, { "description": "HC ASSAY OF ETHANOL - G0480 - 30100052", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1165.0, "minimum": 33.0774, "maximum": 1060.8233, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 553.74 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 443.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 553.74 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 553.74 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1060.82 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 173.49, "10th_percentile": 173.49, "90th_percentile": 173.49, "count": "1 through 10" }, { "payer_name": "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 432.75, "10th_percentile": 164.25, "90th_percentile": 1052.5, "count": "14" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 95.76, "10th_percentile": 95.76, "90th_percentile": 95.76, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 363.48, "10th_percentile": 363.48, "90th_percentile": 375.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 132.48, "10th_percentile": 132.48, "90th_percentile": 257.04, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 132.77, "10th_percentile": 132.77, "90th_percentile": 337.54, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 55.85, "10th_percentile": 55.85, "90th_percentile": 55.85, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL Q4199) CYGNUS MATRIX, PER SQ CM", "code_information": [ { "code": "Q4199", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1047.123, "maximum": 1561.64, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1561.64 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1249.3 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1561.64 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1561.64 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1047.12 } ] } ] }, { "description": "HC X-RAY PELVIS 3+ VW", "code_information": [ { "code": "72190", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 616.88, "discounted_cash": 178.0, "minimum": 111.54, "maximum": 559.5102, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 113.78 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 139.42 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 171.15, "10th_percentile": 171.15, "90th_percentile": 171.15, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 111.54 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 139.42 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 139.42 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 256.57 } ] } ] }, { "description": "HC (SUP SHELL A4344) CATH INDW FOLEY 2 WAY SILICN - A4344 - RU278116", "code_information": [ { "code": "A4344", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 22.81, "maximum": 22.81, "payers_information": [ { "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" } ] } ] }, { "description": "Amikacin Sulfate Inj 1 GM/4ML (250 MG/ML)", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "25021017302", "type": "NDC" }, { "code": "J0278", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.89, "maximum": 16.45, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.45 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2.82 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2.25 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2.82 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2.82 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.89 } ] } ] }, { "description": "SKIN DEBRIDEMENT WITHOUT CCMCC", "code_information": [ { "code": "572", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6276.0, "minimum": 6276.87, "maximum": 13513.71, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13513.71 } ] } ] }, { "description": "HC MR ANGIO, HEAD W/CONTRAST", "code_information": [ { "code": "70545", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2434.38, "discounted_cash": 705.0, "minimum": 705.9702, "maximum": 2207.9827, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2118.32 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1694.64 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2118.32 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2118.32 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1502.97 } ] } ] }, { "description": "ENDOCRINE DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "645", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6052.0, "minimum": 6052.7, "maximum": 9057.47, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9057.47 } ] } ] }, { "description": "Midazolam HCl Oral/Rectal/Inj 5 MG/5ML (Base Equivalent)", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "00641605910", "type": "NDC" }, { "code": "J2250", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.76, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 126.67, "10th_percentile": 126.67, "90th_percentile": 126.67, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.76 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC FRACTURE ASSESSMENT VIA DXA", "code_information": [ { "code": "77086", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 264.38, "discounted_cash": 76.0, "minimum": 76.6702, "maximum": 239.7927, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 109.41 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 134.07 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 107.26 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 134.07 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 134.07 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 217.1 } ] } ] }, { "description": "HC COAGULATION TIME, ACTIVATED", "code_information": [ { "code": "85347", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 58.44, "discounted_cash": 16.0, "minimum": 4.28, "maximum": 53.0051, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 35.16 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 43.09 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 34.47 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 43.09 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 43.09 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.68 }, { "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" } ] } ] }, { "description": "Insulin Lispro Soln Pen-injector 100 Unit/ML (1 Unit Dial) - 00002822259 - 25000001", "drug_information": { "unit": 3.0, "type": "ML" }, "code_information": [ { "code": "00002822259", "type": "NDC" }, { "code": "J1815", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 13.8, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.8 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.08 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.08 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.08 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC STREP A ASSAY W/OPTIC", "code_information": [ { "code": "87880", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 127.5, "discounted_cash": 36.0, "minimum": 16.53, "maximum": 127.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 68.92, "10th_percentile": 68.92, "90th_percentile": 68.92, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 11.16, "10th_percentile": 10.53, "90th_percentile": 36.72, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 94.58 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 115.89 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 10.15, "10th_percentile": 10.15, "90th_percentile": 33.38, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 92.71 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 115.89 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 115.89 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 78.93, "10th_percentile": 78.92, "90th_percentile": 81.7, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 77.11, "10th_percentile": 77.11, "90th_percentile": 77.11, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 127.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 16.53, "10th_percentile": 9.95, "90th_percentile": 32.73, "count": "1 through 10" }, { "payer_name": "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 96.25, "10th_percentile": 29.25, "90th_percentile": 102.0, "count": "302" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 16.53, "10th_percentile": 9.36, "90th_percentile": 32.73, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 88.17, "10th_percentile": 81.53, "90th_percentile": 92.51, "count": "15" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 32.64, "10th_percentile": 9.92, "90th_percentile": 32.64, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 32.64, "10th_percentile": 30.8, "90th_percentile": 32.73, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 32.73, "10th_percentile": 32.73, "90th_percentile": 32.73, "count": "1 through 10" } ] } ] }, { "description": "HC BORRELIA ANTIBODY", "code_information": [ { "code": "86619", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 277.5, "discounted_cash": 80.0, "minimum": 13.38, "maximum": 251.6925, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 110.46 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 135.35 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 108.28 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 135.35 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 135.35 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 124.04 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.38, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF GENTAMICIN", "code_information": [ { "code": "80170", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 297.81, "discounted_cash": 86.0, "minimum": 16.38, "maximum": 270.1137, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 135.28 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 165.76 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 132.61 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 165.76 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 165.76 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 151.85 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BEHAVIORAL AND DEVELOPMENTAL DISORDERS", "code_information": [ { "code": "886", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13226.0, "minimum": 13226.27, "maximum": 24465.67, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24465.67 } ] } ] }, { "description": "HC (SUP SHELL C9359) IMPLNT,BON VOID FILLER-PUTTY", "code_information": [ { "code": "C9359", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 388.2375, "maximum": 388.2375, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 388.24 } ] } ] }, { "description": "HC NEPHELOMETRY, NOT SPECIFIED", "code_information": [ { "code": "83883", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 169.69, "discounted_cash": 49.0, "minimum": 13.6, "maximum": 153.9088, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 107.55, "10th_percentile": 107.55, "90th_percentile": 107.55, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 93.67 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 114.78 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 103.61, "10th_percentile": 103.61, "90th_percentile": 220.73, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 91.82 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 114.78 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 114.78 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 126.08 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 122.82, "10th_percentile": 42.19, "90th_percentile": 298.75, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 298.75, "10th_percentile": 298.75, "90th_percentile": 298.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 95.6, "10th_percentile": 95.6, "90th_percentile": 95.6, "count": "13" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 110.54, "10th_percentile": 110.54, "90th_percentile": 110.54, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 95.6, "10th_percentile": 95.6, "90th_percentile": 110.54, "count": "28" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 95.6, "10th_percentile": 95.6, "90th_percentile": 191.2, "count": "12" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 95.6, "10th_percentile": 95.6, "90th_percentile": 95.6, "count": "1 through 10" } ] } ] }, { "description": "CHEST PAIN", "code_information": [ { "code": "313", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3810.0, "minimum": 3810.96, "maximum": 8488.07, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8488.07 } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "349", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3810.0, "minimum": 3810.96, "maximum": 10263.49, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10263.49 } ] } ] }, { "description": "OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC", "code_information": [ { "code": "923", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6276.0, "minimum": 6276.87, "maximum": 11997.64, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11997.64 } ] } ] }, { "description": "HC (SUP SHELL A4340) INDWELLING CATHETER SPECIAL - A4340 - 27200064", "code_information": [ { "code": "A4340", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 45.25, "maximum": 45.25, "payers_information": [ { "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" } ] } ] }, { "description": "HC VARICELLA-ZOSTER", "code_information": [ { "code": "86787", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 190.94, "discounted_cash": 55.0, "minimum": 12.88, "maximum": 173.1826, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 106.33 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 130.3 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 104.24 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 130.3 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 130.3 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 119.4 }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 144.0, "10th_percentile": 144.0, "90th_percentile": 152.75, "count": "12" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 48.88, "10th_percentile": 48.88, "90th_percentile": 48.88, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 131.9, "10th_percentile": 131.9, "90th_percentile": 138.54, "count": "1 through 10" } ] } ] }, { "description": "HC TRICHOMONAS VAGIN DIR PROBE", "code_information": [ { "code": "87660", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 81.88, "discounted_cash": 23.0, "minimum": 20.05, "maximum": 81.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 44.21, "10th_percentile": 44.21, "90th_percentile": 44.21, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 23.58, "10th_percentile": 22.23, "90th_percentile": 23.58, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 81.88 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 81.88 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 22.72, "10th_percentile": 22.72, "90th_percentile": 22.72, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 81.88 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 81.88 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 81.88 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 39.33, "10th_percentile": 39.33, "90th_percentile": 41.72, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 51.48, "10th_percentile": 49.47, "90th_percentile": 51.48, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 81.88 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 60.15, "10th_percentile": 60.15, "90th_percentile": 60.15, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 24.06, "10th_percentile": 24.06, "90th_percentile": 24.06, "count": "1 through 10" }, { "payer_name": "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 65.5, "10th_percentile": 61.75, "90th_percentile": 65.5, "count": "127" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 20.96, "10th_percentile": 19.76, "90th_percentile": 20.96, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 59.41, "10th_percentile": 52.35, "90th_percentile": 59.41, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 19.76, "10th_percentile": 19.76, "90th_percentile": 20.96, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 20.96, "10th_percentile": 20.96, "90th_percentile": 21.0, "count": "1 through 10" } ] } ] }, { "description": "Hydromorphone HCl Preservative Free (PF) Inj 10 MG/ML", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "63323085115", "type": "NDC" }, { "code": "J1171", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 12.77, "10th_percentile": 12.77, "90th_percentile": 25.55, "count": "34" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "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": 90.0, "median_amount": 6.25, "10th_percentile": 6.25, "90th_percentile": 6.25, "count": "1 through 10" } ] } ] }, { "description": "Calcium Gluconate-NaCl IV Soln 1 GM/50ML-0.675% (20 MG/ML)", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "44567062001", "type": "NDC" }, { "code": "J0612", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC DRUG SCREEN QUANTITATIVE LAMOTRIGINE", "code_information": [ { "code": "80175", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 329.69, "discounted_cash": 95.0, "minimum": 13.25, "maximum": 299.0288, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 94.95, "10th_percentile": 94.95, "90th_percentile": 94.95, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 102.26 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 125.31 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 100.25 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 125.31 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 125.31 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 168.01, "10th_percentile": 168.01, "90th_percentile": 168.01, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 122.83 }, { "payer_name": "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 12.66, "10th_percentile": 12.66, "90th_percentile": 12.66, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 84.4, "10th_percentile": 84.4, "90th_percentile": 84.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 84.4, "10th_percentile": 84.4, "90th_percentile": 84.4, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 84.58, "10th_percentile": 84.58, "90th_percentile": 84.58, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL L3984) UPPER EXT FX ORTHOSIS WRIST", "code_information": [ { "code": "L3984", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 485.98, "maximum": 485.98, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 485.98, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC CONTRAST BATH THERAPY EA 15 MIN", "code_information": [ { "code": "97034", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 129.69, "discounted_cash": 37.0, "minimum": 13.37, "maximum": 117.6288, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.37, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Belimumab For IV Soln 400 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "49401010201", "type": "NDC" }, { "code": "J0490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 173.1555, "maximum": 641.13, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 641.13 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 258.24 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 206.59 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 258.24 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 258.24 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 173.16 } ] } ] }, { "description": "SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "624", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6949.0, "minimum": 6949.39, "maximum": 14758.62, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14758.62 } ] } ] }, { "description": "HC CULTURE SPEC, BACTERIA, NOT URINE,STOOL,BLOOD", "code_information": [ { "code": "87070", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 238.13, "discounted_cash": 69.0, "minimum": 8.62, "maximum": 215.9839, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 128.7, "10th_percentile": 128.7, "90th_percentile": 128.7, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 68.58, "10th_percentile": 54.99, "90th_percentile": 68.58, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 71.06 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 87.07 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 58.61, "10th_percentile": 52.98, "90th_percentile": 66.07, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 69.66 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 87.07 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 87.07 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 114.5, "10th_percentile": 114.5, "90th_percentile": 130.79, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 127.78, "10th_percentile": 127.78, "90th_percentile": 144.0, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 79.91 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 61.12, "10th_percentile": 50.99, "90th_percentile": 169.0, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 44.28, "10th_percentile": 44.28, "90th_percentile": 44.28, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 179.75, "10th_percentile": 159.5, "90th_percentile": 190.5, "count": "103" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 48.88, "10th_percentile": 8.62, "90th_percentile": 97.92, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 164.65, "10th_percentile": 138.54, "90th_percentile": 172.79, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 54.96, "10th_percentile": 54.96, "90th_percentile": 60.96, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 54.08, "10th_percentile": 54.08, "90th_percentile": 157.42, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 54.08, "10th_percentile": 54.08, "90th_percentile": 54.08, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL L4396) STATIC OR DYNAMI AFO PRE CST", "code_information": [ { "code": "L4396", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 210.28, "maximum": 210.28, "payers_information": [ { "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" } ] } ] }, { "description": "HC XRAY SPINE, COMPLETE, 1 VW", "code_information": [ { "code": "72081", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 431.25, "discounted_cash": 125.0, "minimum": 125.0625, "maximum": 391.1438, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 256.57 } ] } ] }, { "description": "HC MRA PELVIS W CONTRAST - C8918 - 61800007", "code_information": [ { "code": "C8918", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2630.0, "minimum": 762.7, "maximum": 2385.41, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 } ] } ] }, { "description": "HC (SUP SHELL L0630) LSO R POST PNL SJ-T9 PRE CST", "code_information": [ { "code": "L0630", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 194.26, "maximum": 194.26, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 194.26, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC US GUIDANCE, INTRAOPERATIVE", "code_information": [ { "code": "76998", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 754.69, "discounted_cash": 218.0, "minimum": 218.8601, "maximum": 684.5038, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 307.45 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 245.96 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 307.45 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 307.45 } ] } ] }, { "description": "HC DEVELOPMENTAL TST ADMIN PHYS/QHP 1ST HOUR", "code_information": [ { "code": "96112", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 434.38, "discounted_cash": 125.0, "minimum": 95.0, "maximum": 393.9827, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "HC CLOT INHIB PROTEIN C,ACTIV", "code_information": [ { "code": "85303", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 336.25, "discounted_cash": 97.0, "minimum": 13.84, "maximum": 304.9787, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 105.2 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 128.91 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 103.13 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 128.91 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 128.91 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 128.3 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A7526) TRACHEOSTOMY TUBE COLLAR - A7526 - 27100102", "code_information": [ { "code": "A7526", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 4.83, "maximum": 4.83, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.83, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CCMCC", "code_information": [ { "code": "468", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3362.0, "minimum": 3362.61, "maximum": 32396.12, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 32396.12 } ] } ] }, { "description": "Tet Tox-Diph-Acell Pertuss Ad Inj 5-2-15.5 LF-LF-MCG/0.5ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "49281040020", "type": "NDC" }, { "code": "90715", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 123.0705, "maximum": 454.92, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 270.57, "10th_percentile": 259.05, "90th_percentile": 273.04, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 126.83, "10th_percentile": 120.33, "90th_percentile": 126.83, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 454.92 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 183.54 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 122.19, "10th_percentile": 122.19, "90th_percentile": 122.19, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 146.83 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 183.54 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 183.54 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.1, "median_amount": 282.2, "10th_percentile": 282.2, "90th_percentile": 288.89, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 267.78, "10th_percentile": 267.78, "90th_percentile": 267.78, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 123.07 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 352.31, "10th_percentile": 0.01, "90th_percentile": 352.31, "count": "64" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 112.74, "10th_percentile": 106.96, "90th_percentile": 112.74, "count": "21" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 306.18, "10th_percentile": 281.6, "90th_percentile": 322.72, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 112.74, "10th_percentile": 106.96, "90th_percentile": 112.74, "count": "13" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 112.74, "10th_percentile": 112.74, "90th_percentile": 113.65, "count": "12" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 112.74, "10th_percentile": 112.74, "90th_percentile": 113.65, "count": "1 through 10" } ] } ] }, { "description": "HC CSF LEAKAGE DETECTION & LOCALIZATION", "code_information": [ { "code": "78650", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1237.5, "discounted_cash": 358.0, "minimum": 358.875, "maximum": 1237.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1115.99 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1237.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1093.97 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1237.5 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1237.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1237.5 } ] } ] }, { "description": "TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC", "code_information": [ { "code": "086", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6501.0, "minimum": 6501.05, "maximum": 15357.5, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15357.5 } ] } ] }, { "description": "MAJOR CHEST TRAUMA WITH MCC", "code_information": [ { "code": "183", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9415.0, "minimum": 9415.31, "maximum": 18035.96, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "other", "standard_charge_dollar": 9415.31, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 4920.0, "10th_percentile": 4920.0, "90th_percentile": 4920.0, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18035.96 } ] } ] }, { "description": "HC HEPATITIS B , DNA, QUANT", "code_information": [ { "code": "87517", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 806.56, "discounted_cash": 233.0, "minimum": 42.84, "maximum": 731.5499, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 353.54 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 433.21 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 346.57 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 433.21 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 433.21 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 397.15 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 608.75, "10th_percentile": 608.75, "90th_percentile": 645.25, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 585.24, "10th_percentile": 585.24, "90th_percentile": 585.24, "count": "1 through 10" } ] } ] }, { "description": "SKIN ULCERS WITHOUT CCMCC", "code_information": [ { "code": "594", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7173.0, "minimum": 7173.57, "maximum": 10218.69, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10218.69 } ] } ] }, { "description": "ORBITAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "114", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5156.0, "minimum": 5156.0, "maximum": 15950.49, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15950.49 } ] } ] }, { "description": "SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC", "code_information": [ { "code": "556", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6052.0, "minimum": 6052.7, "maximum": 36254.484, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9791.93 } ] } ] }, { "description": "HC X-RAY BILE/PANCREAS ENDOSCOPY", "code_information": [ { "code": "74330", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2076.88, "discounted_cash": 602.0, "minimum": 494.8, "maximum": 1883.7302, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 504.76 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 618.51 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 494.8 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 618.51 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 618.51 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 609.1 } ] } ] }, { "description": "HC (SUP SHELL L1906) AFO MULTILIG ANK SUP PRE OTS", "code_information": [ { "code": "L1906", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 154.75, "maximum": 154.75, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 154.75, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L8509) TRACH-ESOPH VOICE PROS MD IN", "code_information": [ { "code": "L8509", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 131.24, "maximum": 131.24, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 131.24, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY IV PYELOGRAM (IVP)", "code_information": [ { "code": "74400", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2031.56, "discounted_cash": 589.0, "minimum": 331.76, "maximum": 1842.6249, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.44 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 414.7 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 331.76 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 414.7 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 414.7 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 947.41 } ] } ] }, { "description": "HC US,PREG UTER,FET & MAT,+ DETL FET,ADDL", "code_information": [ { "code": "76812", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 780.0, "discounted_cash": 226.0, "minimum": 226.2, "maximum": 780.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 309.28 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 247.42 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 309.28 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 309.28 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 780.0 } ] } ] }, { "description": "HC (SUP SHELL L3995) SOCK FRACTURE OR EQUAL EACH", "code_information": [ { "code": "L3995", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 49.02, "maximum": 49.02, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 49.02, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF APOLIPOPROTEIN", "code_information": [ { "code": "82172", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 255.0, "discounted_cash": 73.0, "minimum": 21.09, "maximum": 231.285, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 73.44, "10th_percentile": 73.44, "90th_percentile": 73.44, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 127.87 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 156.69 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 125.35 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 156.69 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 156.69 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 85.04, "10th_percentile": 85.04, "90th_percentile": 129.95, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 106.95, "10th_percentile": 106.95, "90th_percentile": 160.34, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 195.51 }, { "payer_name": "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 133.5, "10th_percentile": 133.5, "90th_percentile": 242.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 65.28, "10th_percentile": 42.72, "90th_percentile": 65.28, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 65.28, "10th_percentile": 42.72, "90th_percentile": 65.28, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 42.72, "10th_percentile": 42.72, "90th_percentile": 42.72, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 42.72, "10th_percentile": 42.72, "90th_percentile": 69.36, "count": "1 through 10" } ] } ] }, { "description": "HC HCV RNA, PCR, QUALITATIVE", "code_information": [ { "code": "87521", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 491.25, "discounted_cash": 142.0, "minimum": 35.09, "maximum": 445.5638, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 214.99 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 263.43 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 210.75 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 263.43 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 263.43 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 325.3 }, { "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" } ] } ] }, { "description": "MOUTH PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "138", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3586.0, "minimum": 3586.78, "maximum": 10447.39, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10447.39 } ] } ] }, { "description": "HC ORTHOPOXVIRUS AMP PRB EACH", "code_information": [ { "code": "87593", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 170.0, "discounted_cash": 49.0, "minimum": 49.3, "maximum": 170.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 170.0 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A5063) DRAIN OSTOMY POUCH W/FLANGE", "code_information": [ { "code": "A5063", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 3.86, "maximum": 10.66, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.66 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 10.66 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 10.66 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3.86, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE", "code_information": [ { "code": "790", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 40127.0, "minimum": 40127.15, "maximum": 70067.8, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 70067.8 } ] } ] }, { "description": "HC (SUP SHELL A6010) COLLAGEN BASED WOUND FILLER", "code_information": [ { "code": "A6010", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 44.14, "maximum": 74.88, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 74.88 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 59.91 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 74.88 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 74.88 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 44.14, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L0625) LO FLEX L1-BELOW L5 PRE OTS", "code_information": [ { "code": "L0625", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 42.8, "maximum": 42.8, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 42.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL C1713) ANCHR/SCREW OPPOS BN-BN/SFT TISS-BN", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 6804.0, "10th_percentile": 6804.0, "90th_percentile": 6804.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 1603.23, "10th_percentile": 1603.23, "90th_percentile": 1603.23, "count": "1 through 10" } ] } ] }, { "description": "HC MRI, TEMPOROMANDIBULAR JOINT(S)", "code_information": [ { "code": "70336", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1148.44, "discounted_cash": 333.0, "minimum": 333.0476, "maximum": 1148.44, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1148.44 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1148.44 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1148.44 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1148.44 }, { "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": 1148.44 } ] } ] }, { "description": "HC CFTR GENE COM VARIANTS", "code_information": [ { "code": "81220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 850.63, "discounted_cash": 246.0, "minimum": 246.6827, "maximum": 850.63, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 850.63 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 850.63 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 850.63 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 850.63 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 850.63 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 850.63 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 556.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC CT NECK TISSUE CONTRAST", "code_information": [ { "code": "70491", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2634.06, "discounted_cash": 763.0, "minimum": 650.0, "maximum": 2389.0924, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 715.68, "10th_percentile": 715.68, "90th_percentile": 715.68, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1304.92 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 730.8, "10th_percentile": 730.8, "90th_percentile": 730.8, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1043.93 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1304.92 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1304.92 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1051.77 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 589.32, "10th_percentile": 551.16, "90th_percentile": 1314.64, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 2107.25, "10th_percentile": 1988.0, "90th_percentile": 2107.25, "count": "23" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 674.32, "10th_percentile": 636.16, "90th_percentile": 674.32, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 674.32, "10th_percentile": 636.16, "90th_percentile": 674.32, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 674.32, "10th_percentile": 674.32, "90th_percentile": 675.92, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 674.32, "10th_percentile": 674.32, "90th_percentile": 674.32, "count": "1 through 10" } ] } ] }, { "description": "OTHER MENTAL DISORDER DIAGNOSES", "code_information": [ { "code": "887", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6949.0, "minimum": 6949.39, "maximum": 12624.82, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12624.82 } ] } ] }, { "description": "HC ASSAY OF CK (CPK)", "code_information": [ { "code": "82550", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 168.13, "discounted_cash": 48.0, "minimum": 6.51, "maximum": 152.4939, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 48.42, "10th_percentile": 48.42, "90th_percentile": 48.42, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 53.76 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 65.88 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 46.64, "10th_percentile": 46.64, "90th_percentile": 46.64, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 52.7 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 65.88 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 65.88 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 110.29, "10th_percentile": 110.29, "90th_percentile": 110.29, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 60.35 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 134.5, "10th_percentile": 109.06, "90th_percentile": 134.5, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 134.5, "10th_percentile": 134.5, "90th_percentile": 134.5, "count": "22" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 43.04, "10th_percentile": 43.04, "90th_percentile": 43.04, "count": "25" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 121.99, "10th_percentile": 121.99, "90th_percentile": 121.99, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 43.04, "10th_percentile": 43.04, "90th_percentile": 49.77, "count": "18" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 43.04, "10th_percentile": 43.04, "90th_percentile": 43.04, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 43.04, "10th_percentile": 43.04, "90th_percentile": 45.73, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 96.3, "10th_percentile": 96.3, "90th_percentile": 96.3, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL A4259) LANCETS PER BOX", "code_information": [ { "code": "A4259", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.42, "maximum": 31.9, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 25.52 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.42, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY MASTOIDS <3 VW", "code_information": [ { "code": "70120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 606.56, "discounted_cash": 175.0, "minimum": 94.37, "maximum": 550.1499, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 96.27 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 117.96 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 94.37 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 117.96 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 117.96 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 250.97 } ] } ] }, { "description": "HC BCR/ABL1 GENE MAJOR BP", "code_information": [ { "code": "81206", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1550.31, "discounted_cash": 449.0, "minimum": 163.96, "maximum": 1519.9912, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 362.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 443.88 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 355.11 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 443.88 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 443.88 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1519.99 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC BX BREAST W DEVICE MRI GUIDE ADDL LESION", "code_information": [ { "code": "19086", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5855.63, "discounted_cash": 1698.0, "minimum": 900.0, "maximum": 5311.0564, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 } ] } ] }, { "description": "HC CRITICAL CARE, E/M 30-74 MINUTES", "code_information": [ { "code": "99291", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5241.25, "discounted_cash": 1519.0, "minimum": 1519.9625, "maximum": 4753.8138, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 3220.22, "10th_percentile": 3220.22, "90th_percentile": 3220.22, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 2920.81, "10th_percentile": 2920.81, "90th_percentile": 2920.81, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 2096.5, "10th_percentile": 2054.6, "90th_percentile": 2891.93, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 4193.0, "10th_percentile": 4193.0, "90th_percentile": 4193.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 1341.76, "10th_percentile": 1166.72, "90th_percentile": 1341.76, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 3803.05, "10th_percentile": 3803.05, "90th_percentile": 3803.05, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 1341.76, "10th_percentile": 1166.72, "90th_percentile": 1341.76, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 1341.76, "10th_percentile": 1166.72, "90th_percentile": 1341.76, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 1341.76, "10th_percentile": 1341.76, "90th_percentile": 1341.76, "count": "1 through 10" } ] } ] }, { "description": "HC CELLULAR FUNCTION ASSAY STIMUL&DETECT BIOMARKER", "code_information": [ { "code": "86352", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 429.69, "discounted_cash": 124.0, "minimum": 124.6101, "maximum": 429.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 232.16, "10th_percentile": 232.16, "90th_percentile": 232.16, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 429.69 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 429.69 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 119.22, "10th_percentile": 119.22, "90th_percentile": 119.22, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 429.69 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 429.69 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 429.69 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 429.69 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 135.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 343.75, "10th_percentile": 324.25, "90th_percentile": 343.75, "count": "18" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 110.0, "10th_percentile": 103.76, "90th_percentile": 110.0, "count": "12" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 297.01, "10th_percentile": 297.01, "90th_percentile": 297.01, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 110.0, "10th_percentile": 103.76, "90th_percentile": 110.0, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 110.0, "10th_percentile": 110.0, "90th_percentile": 110.25, "count": "12" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 110.0, "10th_percentile": 110.0, "90th_percentile": 110.25, "count": "1 through 10" } ] } ] }, { "description": "HC CATHETERIZE FOR URINE SPEC", "code_information": [ { "code": "P9612", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14.38, "minimum": 4.1702, "maximum": 14.38, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.38 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.38 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 14.38 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 14.38 }, { "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" } ] } ] }, { "description": "Amiodarone HCl in Dextrose 4.21% IV Soln 150 MG/100ML", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "43066015010", "type": "NDC" }, { "code": "J0282", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0395, "maximum": 6.63, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.63 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.55 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.24 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.55 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.55 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.04 } ] } ] }, { "description": "HC NM GASTRIC EMPTYING STUDY", "code_information": [ { "code": "78264", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1104.38, "discounted_cash": 320.0, "minimum": 320.2702, "maximum": 1104.38, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 929.28 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1104.38 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 910.94 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1104.38 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1104.38 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1104.38 } ] } ] }, { "description": "HC (SUP SHELL A6023 )COLLAGEN DRESSING >48 SQ IN", "code_information": [ { "code": "A6023", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 271.22, "maximum": 271.22, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 271.22, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC STAPH A DNA AMP PROBE", "code_information": [ { "code": "87640", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 264.38, "discounted_cash": 76.0, "minimum": 35.09, "maximum": 264.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 142.84, "10th_percentile": 142.84, "90th_percentile": 142.84, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 214.99 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 263.43 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 73.35, "10th_percentile": 69.19, "90th_percentile": 73.35, "count": "11" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 210.75 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 263.43 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 263.43 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 127.08, "10th_percentile": 127.08, "90th_percentile": 134.73, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 166.24, "10th_percentile": 159.82, "90th_percentile": 166.24, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 264.38 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 67.68, "10th_percentile": 67.68, "90th_percentile": 211.5, "count": "1 through 10" }, { "payer_name": "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 Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 67.68, "10th_percentile": 63.84, "90th_percentile": 67.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 182.74, "10th_percentile": 63.84, "90th_percentile": 191.83, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 67.68, "10th_percentile": 67.68, "90th_percentile": 73.82, "count": "16" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 67.83, "10th_percentile": 67.68, "90th_percentile": 67.83, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 67.68, "10th_percentile": 63.84, "90th_percentile": 67.83, "count": "1 through 10" } ] } ] }, { "description": "OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CCMCC", "code_information": [ { "code": "395", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4483.0, "minimum": 4483.48, "maximum": 7651.05, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7651.05 } ] } ] }, { "description": "HC VENOGRAM RENAL BILAT", "code_information": [ { "code": "75833", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9452.81, "discounted_cash": 2741.0, "minimum": 671.1055, "maximum": 8573.6987, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 895.74 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1097.59 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 878.07 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1097.59 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1097.59 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 671.11 } ] } ] }, { "description": "Ceftaroline Fosamil for IV Soln 600 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00456060001", "type": "NDC" }, { "code": "J0712", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 12.5685, "maximum": 42.63, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 42.63 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.74 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 15.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 18.74 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 18.74 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.57 } ] } ] }, { "description": "HC BODY FLUID SPECIFIC GRAVITY", "code_information": [ { "code": "84315", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 52.19, "discounted_cash": 15.0, "minimum": 3.28, "maximum": 47.3363, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 20.69 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.35 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 20.28 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 25.35 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 25.35 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.41 }, { "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" } ] } ] }, { "description": "OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC", "code_information": [ { "code": "206", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5380.0, "minimum": 5380.18, "maximum": 60843.5313, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11094.61 } ] } ] }, { "description": "HC MR ANGIO, NECK, COMBO", "code_information": [ { "code": "70549", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3072.5, "discounted_cash": 891.0, "minimum": 891.025, "maximum": 2786.7575, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2668.87 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2135.09 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2668.87 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2668.87 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2295.29 } ] } ] }, { "description": "HC MRA CHEST W CONTRAST, EXCLUDE HEART - 71555 - 61800004", "code_information": [ { "code": "71555", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3750.94, "discounted_cash": 1087.0, "minimum": 900.0, "maximum": 3402.1026, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2118.32 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1694.64 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2118.32 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2118.32 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2196.61 } ] } ] }, { "description": "HC VASCULAR BIOPSY", "code_information": [ { "code": "75970", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3505.63, "discounted_cash": 1016.0, "minimum": 1016.6327, "maximum": 3179.6064, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1754.96 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2150.43 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1720.34 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2150.43 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2150.43 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3163.76 } ] } ] }, { "description": "Sodium Chloride IV Soln 3%", "drug_information": { "unit": 500.0, "type": "ML" }, "code_information": [ { "code": "00338005403", "type": "NDC" }, { "code": "J7131", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC ACTIVATED PROT C (APC) RESISTNCE ASSAY", "code_information": [ { "code": "85307", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 236.56, "discounted_cash": 68.0, "minimum": 15.32, "maximum": 214.5599, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 117.98 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 144.57 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 115.65 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 144.57 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 144.57 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 142.02 }, { "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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 60.56, "10th_percentile": 60.56, "90th_percentile": 60.56, "count": "1 through 10" } ] } ] }, { "description": "Nicardipine HCl IV Soln 2.5 MG/ML", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "64679063102", "type": "NDC" }, { "code": "J2404", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC MANUAL THERAPY 1/> REGIONS EA 15 MIN", "code_information": [ { "code": "97140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 262.81, "discounted_cash": 76.0, "minimum": 26.55, "maximum": 238.3687, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 26.55, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Ocrelizumab Soln For IV Infusion 300 MG/10ML", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "50242015001", "type": "NDC" }, { "code": "J2350", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 182.1015, "maximum": 840.29, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 840.29 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 271.58 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 217.26 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 271.58 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 271.58 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 182.1 } ] } ] }, { "description": "HC ARC RBC PRETREATMENT,SERUM W DRUGS", "code_information": [ { "code": "86975", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 896.88, "discounted_cash": 260.0, "minimum": 260.0952, "maximum": 813.4702, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 348.29 } ] } ] }, { "description": "HC US, OB >/= 14 WKS, SNGL FETUS", "code_information": [ { "code": "76805", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1121.88, "discounted_cash": 325.0, "minimum": 325.3452, "maximum": 1017.5452, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 475.52 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 380.41 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 475.52 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 475.52 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 752.85 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 897.5, "10th_percentile": 846.75, "90th_percentile": 897.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 814.03, "10th_percentile": 814.03, "90th_percentile": 814.03, "count": "1 through 10" } ] } ] }, { "description": "SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITHOUT CCMCC", "code_information": [ { "code": "458", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5380.0, "minimum": 5380.18, "maximum": 49190.7, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 49190.7 } ] } ] }, { "description": "HC HEPARIN ASSAY", "code_information": [ { "code": "85520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 237.19, "discounted_cash": 68.0, "minimum": 13.09, "maximum": 215.1313, "payers_information": [ { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 132.37 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 132.37 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 121.35 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 108.03 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 132.37 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 105.9 } ] } ] }, { "description": "HC (SUP SHELL Q4131) EPIFIX, PER SQ CM", "code_information": [ { "code": "Q4131", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2360.78, "maximum": 2360.78, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2360.78 } ] } ] }, { "description": "HC (SUP SHELL C9352) MICROPOROUS COLL IMPLANTBLE TUBE CM", "code_information": [ { "code": "C9352", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 3335.094, "maximum": 3335.094, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3335.09 } ] } ] }, { "description": "HC IADNA ENTEROVIRUS AMPLIF PROBE & REV TRNSCRIP", "code_information": [ { "code": "87498", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 455.0, "discounted_cash": 131.0, "minimum": 35.09, "maximum": 412.685, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 214.99 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 263.43 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 210.75 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 263.43 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 263.43 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 325.3 }, { "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" } ] } ] }, { "description": "HC NM LIVER & SPLEEN IMAGE, FLOW", "code_information": [ { "code": "78216", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 774.38, "discounted_cash": 224.0, "minimum": 224.5702, "maximum": 774.38, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 440.57 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 539.85 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 431.88 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 539.85 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 539.85 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 774.38 } ] } ] }, { "description": "OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH CCMCC", "code_information": [ { "code": "749", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11432.0, "minimum": 11432.87, "maximum": 30269.39, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30269.39 } ] } ] }, { "description": "HC ASSAY OF INORGANIC PHOSPHORUS", "code_information": [ { "code": "84100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 60.0, "discounted_cash": 17.0, "minimum": 4.74, "maximum": 54.42, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 34.37, "10th_percentile": 34.37, "90th_percentile": 34.37, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 17.28, "10th_percentile": 17.28, "90th_percentile": 17.28, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 38.33 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 46.97 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 16.65, "10th_percentile": 16.65, "90th_percentile": 16.65, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 37.57 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 46.97 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 46.97 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 30.58, "10th_percentile": 30.58, "90th_percentile": 30.58, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 38.45, "10th_percentile": 37.73, "90th_percentile": 38.45, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 43.94 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 48.0, "10th_percentile": 48.0, "90th_percentile": 48.0, "count": "17" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 48.0, "10th_percentile": 48.0, "90th_percentile": 48.0, "count": "68" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 15.36, "10th_percentile": 15.36, "90th_percentile": 15.36, "count": "33" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 15.36, "10th_percentile": 15.36, "90th_percentile": 17.76, "count": "25" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 15.36, "10th_percentile": 4.74, "90th_percentile": 16.32, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 16.32, "10th_percentile": 15.36, "90th_percentile": 16.32, "count": "13" } ] } ] }, { "description": "HC ASSAY OF VASOPRESSIN", "code_information": [ { "code": "84588", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 675.94, "discounted_cash": 196.0, "minimum": 33.94, "maximum": 613.0776, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 280.17 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 343.3 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 274.64 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 343.3 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 343.3 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 314.64 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH CC", "code_information": [ { "code": "511", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7846.0, "minimum": 7846.09, "maximum": 24514.01, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24514.01 } ] } ] }, { "description": "HC MED NUTR THER, 1ST, INDIV, EA 15 MIN", "code_information": [ { "code": "97802", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 151.56, "discounted_cash": 43.0, "minimum": 25.59, "maximum": 137.4649, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 358.05, "10th_percentile": 358.05, "90th_percentile": 358.05, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 174.6, "10th_percentile": 174.6, "90th_percentile": 174.6, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 310.59, "10th_percentile": 226.16, "90th_percentile": 320.17, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.1, "median_amount": 378.84, "10th_percentile": 378.84, "90th_percentile": 378.84, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 155.2, "10th_percentile": 51.62, "90th_percentile": 157.08, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 25.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 98.16, "10th_percentile": 73.62, "90th_percentile": 98.16, "count": "12" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 86.42, "10th_percentile": 86.42, "90th_percentile": 115.23, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 439.9, "10th_percentile": 439.9, "90th_percentile": 439.9, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 155.2, "10th_percentile": 155.2, "90th_percentile": 155.2, "count": "1 through 10" } ] } ] }, { "description": "Insulin Regular (Human) in NaCl 0.9% IV Soln 100 Unit/100ML", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "00338012612", "type": "NDC" }, { "code": "J1815", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 13.8, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.8 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.08 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.08 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.08 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC (SUP SHELL A4367) OSTOMY BELT", "code_information": [ { "code": "A4367", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 10.49, "maximum": 31.57, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 31.57 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 25.26 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 31.57 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 31.57 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 10.49, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L3919) HO W/O JOINTS CF", "code_information": [ { "code": "L3919", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 295.66, "maximum": 295.66, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 295.66, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC IADNA RESPIRATRY PROBE & REV TRNSCR 12-25 TARGT", "code_information": [ { "code": "87633", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 495.63, "discounted_cash": 143.0, "minimum": 143.7327, "maximum": 495.63, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 495.63 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 495.63 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 495.63 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 495.63 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 495.63 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 299.61, "10th_percentile": 299.61, "90th_percentile": 299.61, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 495.63 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 36.24, "10th_percentile": 36.24, "90th_percentile": 36.24, "count": "1 through 10" }, { "payer_name": "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 374.0, "10th_percentile": 374.0, "90th_percentile": 396.5, "count": "52" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 119.68, "10th_percentile": 119.68, "90th_percentile": 119.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 359.63, "10th_percentile": 359.63, "90th_percentile": 719.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 126.88, "10th_percentile": 119.68, "90th_percentile": 138.38, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 127.16, "10th_percentile": 127.16, "90th_percentile": 127.16, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 127.16, "10th_percentile": 127.16, "90th_percentile": 127.16, "count": "1 through 10" } ] } ] }, { "description": "HC COLLECTION VENOUS BLOOD,VENIPUNCTURE", "code_information": [ { "code": "36415", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40.0, "discounted_cash": 11.0, "minimum": 9.34, "maximum": 36.28, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 22.91, "10th_percentile": 22.91, "90th_percentile": 24.8, "count": "99" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 11.52, "10th_percentile": 11.52, "90th_percentile": 11.52, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.96 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.78 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 11.1, "10th_percentile": 11.1, "90th_percentile": 11.1, "count": "543" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 16.62 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 20.78 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 20.78 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 20.38, "10th_percentile": 20.38, "90th_percentile": 20.38, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 32.0, "10th_percentile": 32.0, "90th_percentile": 32.0, "count": "654" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 7.44, "10th_percentile": 7.33, "90th_percentile": 7.44, "count": "22" }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 32.0, "10th_percentile": 32.0, "90th_percentile": 32.0, "count": "1651" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 10.24, "10th_percentile": 10.24, "90th_percentile": 10.88, "count": "1422" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 29.02, "10th_percentile": 29.02, "90th_percentile": 29.31, "count": "137" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 10.24, "10th_percentile": 10.24, "90th_percentile": 11.84, "count": "1119" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 10.24, "10th_percentile": 10.24, "90th_percentile": 10.88, "count": "187" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 10.24, "10th_percentile": 10.24, "90th_percentile": 10.88, "count": "662" } ] } ] }, { "description": "SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC", "code_information": [ { "code": "623", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11657.0, "minimum": 11657.05, "maximum": 21148.25, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21148.25 } ] } ] }, { "description": "HC ALPHA-FETOPROTEIN, SERUM", "code_information": [ { "code": "82105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 275.31, "discounted_cash": 79.0, "minimum": 16.77, "maximum": 249.7062, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 138.44 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 169.64 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 76.39, "10th_percentile": 76.39, "90th_percentile": 76.39, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 135.71 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 169.64 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 169.64 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 155.47 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 171.1, "10th_percentile": 25.4, "90th_percentile": 220.25, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 220.25, "10th_percentile": 220.25, "90th_percentile": 220.25, "count": "12" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 74.89, "10th_percentile": 74.89, "90th_percentile": 74.89, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 70.48, "10th_percentile": 70.48, "90th_percentile": 70.48, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 70.48, "10th_percentile": 70.48, "90th_percentile": 70.48, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 70.48, "10th_percentile": 70.48, "90th_percentile": 70.48, "count": "1 through 10" } ] } ] }, { "description": "HC ASSAY OF VALPROIC ACID, TOTAL", "code_information": [ { "code": "80164", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 210.0, "discounted_cash": 60.0, "minimum": 13.54, "maximum": 190.47, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 60.48, "10th_percentile": 57.06, "90th_percentile": 60.48, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 111.82 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 137.02 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 109.61 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 137.02 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 137.02 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 107.02, "10th_percentile": 107.02, "90th_percentile": 107.02, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 125.52 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 28.96, "10th_percentile": 7.66, "90th_percentile": 145.66, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 168.0, "10th_percentile": 158.5, "90th_percentile": 168.0, "count": "11" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 50.72, "10th_percentile": 13.54, "90th_percentile": 53.76, "count": "15" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 50.72, "10th_percentile": 50.72, "90th_percentile": 50.72, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 53.89, "10th_percentile": 53.89, "90th_percentile": 53.89, "count": "1 through 10" } ] } ] }, { "description": "OTHER HEART ASSIST SYSTEM IMPLANT", "code_information": [ { "code": "215", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10536.0, "minimum": 10536.18, "maximum": 117382.87, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 117382.87 } ] } ] }, { "description": "ALLERGIC REACTIONS WITH MCC", "code_information": [ { "code": "915", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7846.0, "minimum": 7846.09, "maximum": 19824.35, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19824.35 } ] } ] }, { "description": "HC (SUP SHELL A6259) TRANSPARENT FILM > 48 SQ IN", "code_information": [ { "code": "A6259", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 15.59, "maximum": 15.59, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 15.59, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC US, ABDOMEN LIMITED", "code_information": [ { "code": "76705", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 671.88, "discounted_cash": 194.0, "minimum": 194.8452, "maximum": 609.3952, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 551.14, "10th_percentile": 551.14, "90th_percentile": 551.14, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 293.76, "10th_percentile": 146.88, "90th_percentile": 293.76, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 361.07 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 282.99, "10th_percentile": 266.95, "90th_percentile": 282.99, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 288.86 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 361.07 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 361.07 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 519.79, "10th_percentile": 490.33, "90th_percentile": 519.79, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 641.38, "10th_percentile": 641.38, "90th_percentile": 641.38, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 504.75 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 261.12, "10th_percentile": 246.32, "90th_percentile": 674.48, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 176.8, "10th_percentile": 176.8, "90th_percentile": 351.18, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 816.0, "10th_percentile": 769.75, "90th_percentile": 816.0, "count": "50" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 261.12, "10th_percentile": 246.32, "90th_percentile": 301.36, "count": "21" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 705.09, "10th_percentile": 615.26, "90th_percentile": 740.11, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 261.12, "10th_percentile": 246.32, "90th_percentile": 261.12, "count": "17" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 261.12, "10th_percentile": 261.12, "90th_percentile": 261.72, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 261.12, "10th_percentile": 261.12, "90th_percentile": 301.36, "count": "1 through 10" } ] } ] }, { "description": "HC ED LEVEL 4", "code_information": [ { "code": "99284", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1961.88, "discounted_cash": 568.0, "minimum": 568.9452, "maximum": 1961.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 977.16, "10th_percentile": 977.16, "90th_percentile": 1057.68, "count": "18" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 565.02, "10th_percentile": 491.31, "90th_percentile": 565.02, "count": "49" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 1765.69 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 1961.88 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 544.3, "10th_percentile": 473.3, "90th_percentile": 544.3, "count": "83" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1730.84 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.1, "median_amount": 1364.75, "10th_percentile": 1364.75, "90th_percentile": 1364.75, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 1093.3, "10th_percentile": 1093.3, "90th_percentile": 1233.63, "count": "23" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 79.93, "median_amount": 1254.5, "10th_percentile": 1090.84, "90th_percentile": 2017.43, "count": "21" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 1036.16, "10th_percentile": 348.13, "90th_percentile": 1569.5, "count": "153" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 635.79, "10th_percentile": 635.79, "90th_percentile": 635.79, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1569.5, "10th_percentile": 1364.75, "90th_percentile": 1569.5, "count": "902" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 502.24, "10th_percentile": 436.72, "90th_percentile": 502.24, "count": "118" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 1423.54, "10th_percentile": 1423.54, "90th_percentile": 1423.54, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 502.24, "10th_percentile": 436.72, "90th_percentile": 708.4, "count": "148" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 502.24, "10th_percentile": 436.72, "90th_percentile": 502.24, "count": "108" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 502.24, "10th_percentile": 436.72, "90th_percentile": 502.24, "count": "51" } ] } ] }, { "description": "HC CYTOPATH FLUIDS,CONCENTRATN,INTERP", "code_information": [ { "code": "88108", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 250.63, "discounted_cash": 72.0, "minimum": 72.6827, "maximum": 250.63, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 250.63 } ] } ] }, { "description": "Morphine Sulfate IV Soln PF 2 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "63323045201", "type": "NDC" }, { "code": "J2270", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 14.5845, "maximum": 35.73, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 13.54, "10th_percentile": 13.54, "90th_percentile": 13.54, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 35.73 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 17.4 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 21.75 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 21.75 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.58 } ] } ] }, { "description": "HC (SUP SHELL L1220) ANTERIOR THORACIC EXTENSION", "code_information": [ { "code": "L1220", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 254.58, "maximum": 254.58, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 254.58, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC ECHO HEART XTHORACIC,LIMITED", "code_information": [ { "code": "93308", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1870.94, "discounted_cash": 542.0, "minimum": 542.5726, "maximum": 1696.9426, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 1159.98, "10th_percentile": 1159.98, "90th_percentile": 1159.98, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 958.52, "10th_percentile": 958.52, "90th_percentile": 976.93, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 519.08, "10th_percentile": 519.08, "90th_percentile": 519.08, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 79.93, "median_amount": 1196.35, "10th_percentile": 1196.35, "90th_percentile": 1196.35, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1496.75, "10th_percentile": 1496.75, "90th_percentile": 1496.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 478.96, "10th_percentile": 478.96, "90th_percentile": 508.9, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 110.76, "10th_percentile": 110.76, "90th_percentile": 478.96, "count": "1 through 10" } ] } ] }, { "description": "MAJOR HEAD AND NECK PROCEDURES WITH CC", "code_information": [ { "code": "141", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6725.0, "minimum": 6725.22, "maximum": 25712.94, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25712.94 } ] } ] }, { "description": "HC CYTOPATH,OTHR SOURC,SCREEN,INTERP", "code_information": [ { "code": "88160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 172.19, "discounted_cash": 49.0, "minimum": 49.9351, "maximum": 172.19, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 172.19 } ] } ] }, { "description": "HC IMHISTOCHEM/CYTCHM 1ST SEP IDENT ANTIBODY SLIDE", "code_information": [ { "code": "88342", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 423.44, "discounted_cash": 122.0, "minimum": 122.7976, "maximum": 423.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 121.95, "10th_percentile": 121.95, "90th_percentile": 243.9, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 221.1, "10th_percentile": 216.94, "90th_percentile": 221.11, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 117.48, "10th_percentile": 117.48, "90th_percentile": 117.48, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 423.44 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 108.4, "10th_percentile": 108.4, "90th_percentile": 108.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 108.4, "10th_percentile": 108.4, "90th_percentile": 2474.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 108.4, "10th_percentile": 108.4, "90th_percentile": 115.18, "count": "1 through 10" } ] } ] }, { "description": "HC CYTOPATH SMEAR OTHER SOURCE", "code_information": [ { "code": "88162", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 244.69, "discounted_cash": 70.0, "minimum": 70.9601, "maximum": 244.69, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 244.69 } ] } ] }, { "description": "KIDNEY AND URINARY TRACT NEOPLASMS WITH MCC", "code_information": [ { "code": "686", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11432.0, "minimum": 11432.87, "maximum": 21263.78, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21263.78 } ] } ] }, { "description": "HC (SUP SHELL Q4345) MATRIX HD ALLOGRFT PER SQ CM", "code_information": [ { "code": "Q4345", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 9583.41, "maximum": 11979.39, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 11979.39 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9583.41 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 11979.39 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 11979.39 } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CCMCC", "code_information": [ { "code": "218", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9639.0, "minimum": 9639.48, "maximum": 77516.08, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 77516.08 } ] } ] }, { "description": "Acetylcysteine Inj 200 MG/ML", "drug_information": { "unit": 30.0, "type": "ML" }, "code_information": [ { "code": "55150025930", "type": "NDC" }, { "code": "J0132", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.4175, "maximum": 18.1, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.1 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2.11 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.69 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2.11 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2.11 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.42 } ] } ] }, { "description": "UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MCC", "code_information": [ { "code": "739", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11432.0, "minimum": 11432.87, "maximum": 42237.56, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 42237.56 } ] } ] }, { "description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "476", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6052.0, "minimum": 6052.7, "maximum": 13913.35, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13913.35 } ] } ] }, { "description": "OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "272", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3810.0, "minimum": 3810.96, "maximum": 30097.27, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30097.27 } ] } ] }, { "description": "Glucagon HCl (rDNA) For Inj 1 MG (Base Equiv)", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00548585000", "type": "NDC" }, { "code": "J1610", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 600.894, "maximum": 2900.23, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2900.23 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 896.15 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 716.91 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 896.15 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 896.15 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 600.89 } ] } ] }, { "description": "HC ANGIO PULMON UNILAT SELECT", "code_information": [ { "code": "75741", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1672.81, "discounted_cash": 485.0, "minimum": 485.1149, "maximum": 1517.2387, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 846.11 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1036.78 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 829.42 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1036.78 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1036.78 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 597.76 } ] } ] }, { "description": "HC US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE", "code_information": [ { "code": "76700", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1398.13, "discounted_cash": 405.0, "minimum": 376.09, "maximum": 1268.1039, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 755.56, "10th_percentile": 755.56, "90th_percentile": 755.56, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 402.66, "10th_percentile": 402.66, "90th_percentile": 402.66, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 470.11 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 387.9, "10th_percentile": 387.9, "90th_percentile": 387.9, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 376.09 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 470.11 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 470.11 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 665.44 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 357.92, "10th_percentile": 357.92, "90th_percentile": 357.92, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1118.5, "10th_percentile": 1055.25, "90th_percentile": 1118.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 337.68, "10th_percentile": 337.68, "90th_percentile": 337.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 357.92, "10th_percentile": 357.92, "90th_percentile": 357.92, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 357.92, "10th_percentile": 357.92, "90th_percentile": 357.92, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 358.79, "10th_percentile": 358.79, "90th_percentile": 358.79, "count": "1 through 10" } ] } ] }, { "description": "DYSEQUILIBRIUM", "code_information": [ { "code": "149", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4259.0, "minimum": 4259.31, "maximum": 11555.28, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8860.6 } ] } ] }, { "description": "HC (SUP SHELL L2624) HIP ADJ FLEX EXT ABDUCT CONT", "code_information": [ { "code": "L2624", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 380.52, "maximum": 380.52, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 380.52, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC HLA CLASS II TYPING HIGH RESOLUTION ONE LOCUS EA", "code_information": [ { "code": "81382", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1075.94, "discounted_cash": 312.0, "minimum": 123.68, "maximum": 1075.94, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 555.3 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 680.44 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 544.35 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 680.44 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 680.44 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1075.94 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 123.68, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC BASIC METABOLIC PANEL CALCIUM TOTAL", "code_information": [ { "code": "80048", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 226.56, "discounted_cash": 65.0, "minimum": 8.46, "maximum": 205.4899, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 122.44, "10th_percentile": 122.44, "90th_percentile": 132.53, "count": "12" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 65.25, "10th_percentile": 61.56, "90th_percentile": 65.25, "count": "67" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 69.87 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 85.62 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 62.86, "10th_percentile": 59.3, "90th_percentile": 62.86, "count": "70" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 68.49 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 85.62 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 85.62 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 115.46, "10th_percentile": 108.93, "90th_percentile": 145.18, "count": "14" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 136.99, "10th_percentile": 136.99, "90th_percentile": 142.46, "count": "22" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 78.43 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 37.02, "10th_percentile": 25.68, "90th_percentile": 181.25, "count": "52" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 39.16, "10th_percentile": 39.16, "90th_percentile": 39.75, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 181.25, "10th_percentile": 171.0, "90th_percentile": 181.25, "count": "218" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 58.0, "10th_percentile": 8.46, "90th_percentile": 58.0, "count": "197" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 164.39, "10th_percentile": 156.64, "90th_percentile": 164.39, "count": "13" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 58.0, "10th_percentile": 54.72, "90th_percentile": 58.0, "count": "138" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 58.0, "10th_percentile": 54.72, "90th_percentile": 58.14, "count": "37" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 58.0, "10th_percentile": 54.72, "90th_percentile": 58.14, "count": "91" } ] } ] }, { "description": "LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH CC", "code_information": [ { "code": "493", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9415.0, "minimum": 9415.31, "maximum": 29898.03, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 29898.03 } ] } ] }, { "description": "SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS", "code_information": [ { "code": "870", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 28470.0, "minimum": 28470.1, "maximum": 81483.07, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 81483.07 } ] } ] }, { "description": "CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC", "code_information": [ { "code": "073", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9191.0, "minimum": 9191.13, "maximum": 18913.06, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18913.06 } ] } ] }, { "description": "HC IV INFU, THERAP/PROPH/DIAGN,CONCURRENT INF", "code_information": [ { "code": "96368", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 402.81, "discounted_cash": 116.0, "minimum": 116.8149, "maximum": 365.3487, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 230.73, "10th_percentile": 230.73, "90th_percentile": 230.73, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 164.1, "10th_percentile": 131.28, "90th_percentile": 164.1, "count": "12" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 256.25, "10th_percentile": 256.25, "90th_percentile": 256.25, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 82.0, "10th_percentile": 82.0, "90th_percentile": 82.0, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 87.13, "10th_percentile": 87.13, "90th_percentile": 87.13, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL Q4173) PALINGEN OR PALINGEN XPLUS", "code_information": [ { "code": "Q4173", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1135.6065, "maximum": 3748.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3748.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1693.6 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1354.87 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1693.6 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1693.6 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1135.61 } ] } ] }, { "description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CCMCC", "code_information": [ { "code": "561", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6501.0, "minimum": 6501.05, "maximum": 20515.5635, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "other", "standard_charge_dollar": 6501.05, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 15599.36, "10th_percentile": 15599.36, "90th_percentile": 19499.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 6501.05, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 13816.75, "10th_percentile": 13816.75, "90th_percentile": 13816.75, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9477.16 } ] } ] }, { "description": "HC CHEMOTHER, IV INFUSION, 1 HR", "code_information": [ { "code": "96413", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1449.06, "discounted_cash": 420.0, "minimum": 420.2274, "maximum": 1314.2974, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 417.33, "10th_percentile": 417.33, "90th_percentile": 417.33, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 742.38, "10th_percentile": 720.58, "90th_percentile": 742.38, "count": "44" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 382.87, "10th_percentile": 382.87, "90th_percentile": 402.03, "count": "18" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.1, "median_amount": 928.56, "10th_percentile": 905.28, "90th_percentile": 928.56, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 1159.25, "10th_percentile": 1104.0, "90th_percentile": 1159.25, "count": "25" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1104.0, "10th_percentile": 1104.0, "90th_percentile": 1159.25, "count": "50" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 370.96, "10th_percentile": 353.28, "90th_percentile": 375.36, "count": "37" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 370.96, "10th_percentile": 353.28, "90th_percentile": 408.48, "count": "30" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 370.96, "10th_percentile": 370.96, "90th_percentile": 375.36, "count": "33" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 370.96, "10th_percentile": 353.28, "90th_percentile": 375.36, "count": "32" } ] } ] }, { "description": "MAJOR CHEST PROCEDURES WITH CC", "code_information": [ { "code": "164", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7621.0, "minimum": 7621.92, "maximum": 29755.39, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 29755.39 } ] } ] }, { "description": "Hydroxyzine HCl Tab 50 MG", "drug_information": { "unit": 100.0, "type": "EA" }, "code_information": [ { "code": "00904661861", "type": "NDC" }, { "code": "Q0177", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 3.68, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.68 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC (SUP SHELL A4461) SURGICL DRESS HOLD NON-REUSE - A4461 - RU272032", "code_information": [ { "code": "A4461", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 4.7, "maximum": 4.7, "payers_information": [ { "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" } ] } ] }, { "description": "HC (SUP SHELL A6457) TUBULAR DRESSING - A6457 - 27090041", "code_information": [ { "code": "A6457", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.62, "maximum": 1.62, "payers_information": [ { "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" } ] } ] }, { "description": "HC REPR WND SMP BODY/SCALP/EXTR 2.6-7.5 CM", "code_information": [ { "code": "12002", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 497.5, "discounted_cash": 144.0, "minimum": 144.275, "maximum": 451.2325, "payers_information": [ { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 155.15, "10th_percentile": 155.15, "90th_percentile": 155.15, "count": "1 through 10" } ] } ] }, { "description": "OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC", "code_information": [ { "code": "963", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12329.0, "minimum": 3378.7267, "maximum": 32228.71, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 32228.71 } ] } ] }, { "description": "KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC", "code_information": [ { "code": "696", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5156.0, "minimum": 1795.1371, "maximum": 8122.61, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 5156.0, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 2143.82, "10th_percentile": 2143.82, "90th_percentile": 2143.82, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8122.61 } ] } ] }, { "description": "LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITH CCMCC", "code_information": [ { "code": "498", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9863.0, "minimum": 9863.66, "maximum": 35564.99, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 35564.99 } ] } ] }, { "description": "HC X-RAY NECK SOFT TISSUE", "code_information": [ { "code": "70360", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 428.44, "discounted_cash": 124.0, "minimum": 71.49, "maximum": 388.5951, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 72.93 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 89.36 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 71.49 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 89.36 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 89.36 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 191.76 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 315.5, "10th_percentile": 161.63, "90th_percentile": 334.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 100.96, "10th_percentile": 100.96, "90th_percentile": 100.96, "count": "1 through 10" } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC", "code_information": [ { "code": "616", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19727.0, "minimum": 19727.31, "maximum": 41112.89, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 41112.89 } ] } ] }, { "description": "COAGULATION DISORDERS", "code_information": [ { "code": "813", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8070.0, "minimum": 8070.26, "maximum": 105940.4895, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 8070.26, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 60447.52, "10th_percentile": 60447.52, "90th_percentile": 60447.52, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17981.73 } ] } ] }, { "description": "HC (SUP SHELL L3808) WHFO, RIGID W/O JOINTS", "code_information": [ { "code": "L3808", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 461.17, "maximum": 461.17, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 461.17, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL E0990) WHEELCHAIR ELEVATING LEG RES", "code_information": [ { "code": "E0990", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 79.35, "maximum": 79.35, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 79.35, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC US GUIDE FOR NEEDLE PLACEMENT", "code_information": [ { "code": "76942", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 985.0, "discounted_cash": 285.0, "minimum": 239.7049, "maximum": 893.395, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 605.4 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 741.82 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 593.46 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 741.82 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 741.82 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 239.7 } ] } ] }, { "description": "DIGESTIVE MALIGNANCY WITH CC", "code_information": [ { "code": "375", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7846.0, "minimum": 7846.09, "maximum": 14259.95, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14259.95 } ] } ] }, { "description": "HC PROTOZOA, NOT ELSEWHERE", "code_information": [ { "code": "86753", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 140.94, "discounted_cash": 40.0, "minimum": 12.39, "maximum": 127.8326, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 76.83 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 94.14 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 75.31 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 94.14 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 94.14 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 114.86 }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 106.25, "10th_percentile": 106.25, "90th_percentile": 106.25, "count": "1 through 10" } ] } ] }, { "description": "CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC", "code_information": [ { "code": "259", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5380.0, "minimum": 5380.18, "maximum": 23838.5, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23838.5 } ] } ] }, { "description": "HC (SUP SHELL L8613) OSSICULAR IMPLANT", "code_information": [ { "code": "L8613", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 382.5, "maximum": 382.5, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 382.5, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC PHOSPHATIDYLGLYCEROL", "code_information": [ { "code": "84081", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 236.56, "discounted_cash": 68.0, "minimum": 16.52, "maximum": 214.5599, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 136.35 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 167.08 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 133.66 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 167.08 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 167.08 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 153.15 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.52, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Heparin Sodium (Porcine)-Dextrose IV Sol 25000 Unit/500ML-5%", "drug_information": { "unit": 500.0, "type": "ML" }, "code_information": [ { "code": "63323052201", "type": "NDC" }, { "code": "j1644", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 2.95, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2.95 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.03 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.03 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.03 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC APPL ON-BODY INJECTOR FOR TIMED SUBQ INJECTION", "code_information": [ { "code": "96377", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 201.88, "discounted_cash": 58.0, "minimum": 58.5452, "maximum": 183.1052, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 103.42, "10th_percentile": 103.42, "90th_percentile": 103.42, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 56.01, "10th_percentile": 56.01, "90th_percentile": 56.01, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 161.5, "10th_percentile": 161.5, "90th_percentile": 161.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 51.68, "10th_percentile": 51.68, "90th_percentile": 51.68, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL A6204) COMPOSITE DRSG >16<=48 SQ IN - A6204 - 27200116", "code_information": [ { "code": "A6204", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 8.86, "maximum": 8.86, "payers_information": [ { "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" } ] } ] }, { "description": "HC ULTRASOUND ELASTOGRAPHY EA ADDL TAGET LESION", "code_information": [ { "code": "76983", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 474.06, "discounted_cash": 137.0, "minimum": 137.4774, "maximum": 429.9724, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 312.98 } ] } ] }, { "description": "HC FLUORESCENT ANTIBODY; TITER", "code_information": [ { "code": "86256", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 269.69, "discounted_cash": 78.0, "minimum": 12.05, "maximum": 244.6088, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 99.49 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 121.92 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 97.53 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 121.92 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 121.92 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 111.71 }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 203.5, "10th_percentile": 203.5, "90th_percentile": 203.5, "count": "1 through 10" } ] } ] }, { "description": "HC GALECTIC-3 LEVEL", "code_information": [ { "code": "82777", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 368.13, "discounted_cash": 106.0, "minimum": 44.25, "maximum": 368.13, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 100.63 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 123.3 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 98.64 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 123.3 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 123.3 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 368.13 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 44.25, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "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": 735.0, "minimum": 650.0, "maximum": 2300.0976, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1691.07 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1352.85 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1691.07 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1691.07 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1215.32 } ] } ] }, { "description": "HC NM THYROID IMAGING WITH VASCULAR FLOW", "code_information": [ { "code": "78013", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 818.44, "discounted_cash": 237.0, "minimum": 237.3476, "maximum": 818.44, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 643.34 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 788.32 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 630.65 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 788.32 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 788.32 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 818.44 } ] } ] }, { "description": "HC X-RAY JAW <4 VW", "code_information": [ { "code": "70100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 670.0, "discounted_cash": 194.0, "minimum": 82.95, "maximum": 607.69, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 84.62 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 103.69 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 82.95 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 103.69 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 103.69 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 256.57 } ] } ] }, { "description": "LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC", "code_information": [ { "code": "840", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15243.0, "minimum": 15243.83, "maximum": 38136.17, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 38136.17 } ] } ] }, { "description": "CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT", "code_information": [ { "code": "838", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11432.0, "minimum": 11432.87, "maximum": 24608.32, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24608.32 } ] } ] }, { "description": "HC FETAL CONGENITAL ABNOR ASSAY FOUR ANAL", "code_information": [ { "code": "81511", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 490.31, "discounted_cash": 142.0, "minimum": 142.1899, "maximum": 490.31, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 490.31 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 490.31 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 490.31 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 490.31 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 490.31 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 490.31 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 153.5, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF SERUM ALBUMIN", "code_information": [ { "code": "82040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 45.31, "discounted_cash": 13.0, "minimum": 4.95, "maximum": 45.31, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 23.91 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 29.3 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 12.58, "10th_percentile": 12.58, "90th_percentile": 12.58, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 23.44 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 29.3 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 29.3 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 45.31 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 36.25, "10th_percentile": 36.25, "90th_percentile": 36.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 11.6, "10th_percentile": 11.6, "90th_percentile": 12.33, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 11.6, "10th_percentile": 11.6, "90th_percentile": 13.41, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL A6449) LT COMPRES BAND >=3 <5/YD - A6449 - 27100025", "code_information": [ { "code": "A6449", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2.5, "maximum": 2.5, "payers_information": [ { "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" } ] } ] }, { "description": "Micafungin Sodium For IV Soln 100 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "63323072901", "type": "NDC" }, { "code": "J2248", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 12.65, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.65 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.22 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.22 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.22 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC CHEMILUMINESCENT ASSAY", "code_information": [ { "code": "82397", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 152.19, "discounted_cash": 44.0, "minimum": 14.12, "maximum": 138.0363, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 88.24 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 108.13 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 86.5 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 108.13 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 108.13 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 130.9 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 121.75, "10th_percentile": 121.75, "90th_percentile": 121.75, "count": "1 through 10" } ] } ] }, { "description": "HC PROTEIN E-PHORESIS, SERUM", "code_information": [ { "code": "84165", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 286.88, "discounted_cash": 83.0, "minimum": 10.74, "maximum": 260.2002, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 164.32, "10th_percentile": 164.32, "90th_percentile": 164.32, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 82.62, "10th_percentile": 78.66, "90th_percentile": 82.62, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 88.64 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 108.62 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 79.59, "10th_percentile": 79.59, "90th_percentile": 104.44, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 86.89 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 108.62 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 108.62 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 99.57 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 229.5, "10th_percentile": 229.5, "90th_percentile": 229.5, "count": "1 through 10" }, { "payer_name": "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 229.5, "10th_percentile": 229.5, "90th_percentile": 229.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 73.44, "10th_percentile": 10.74, "90th_percentile": 73.44, "count": "20" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 84.92, "10th_percentile": 84.92, "90th_percentile": 208.16, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 73.44, "10th_percentile": 69.92, "90th_percentile": 84.92, "count": "33" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 73.44, "10th_percentile": 73.44, "90th_percentile": 73.44, "count": "12" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 69.92, "10th_percentile": 69.92, "90th_percentile": 73.44, "count": "1 through 10" } ] } ] }, { "description": "HC DEOXYCORTISOL", "code_information": [ { "code": "82634", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 395.94, "discounted_cash": 114.0, "minimum": 29.28, "maximum": 359.1176, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 241.61 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 296.06 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 236.85 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 296.06 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 296.06 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 271.44 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC IMHISTOCHEM/CYTCHM EA ADD SEP IDENT ANTIBODY SLIDE", "code_information": [ { "code": "88341", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 444.69, "discounted_cash": 128.0, "minimum": 128.9601, "maximum": 444.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 121.95, "10th_percentile": 121.95, "90th_percentile": 121.95, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 1301.61, "10th_percentile": 1301.61, "90th_percentile": 1301.61, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 352.44, "10th_percentile": 352.44, "90th_percentile": 704.87, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 444.69 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 542.0, "10th_percentile": 542.0, "90th_percentile": 542.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 115.18, "10th_percentile": 115.18, "90th_percentile": 115.18, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL Q4160) NUSHIELD 1 SQ CM", "code_information": [ { "code": "Q4160", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 291.8475, "maximum": 3200.8, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3200.8 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 435.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 348.2 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 435.25 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 435.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 291.85 } ] } ] }, { "description": "SIMPLE PNEUMONIA AND PLEURISY WITH CC", "code_information": [ { "code": "194", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6276.0, "minimum": 6276.87, "maximum": 13966.3917, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "other", "standard_charge_dollar": 6276.87, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 17549.28, "10th_percentile": 17549.28, "90th_percentile": 17549.28, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 6276.87, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 8575.28, "10th_percentile": 6431.46, "90th_percentile": 10719.1, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "other", "standard_charge_dollar": 6276.87, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 9840.0, "10th_percentile": 9840.0, "90th_percentile": 9840.0, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9500.74 } ] } ] }, { "description": "HC ED LEVEL 2", "code_information": [ { "code": "99282", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 523.13, "discounted_cash": 151.0, "minimum": 151.7077, "maximum": 523.13, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 418.5, "10th_percentile": 364.0, "90th_percentile": 418.5, "count": "733" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 123.76, "10th_percentile": 116.48, "90th_percentile": 133.92, "count": "74" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 333.42, "10th_percentile": 333.42, "90th_percentile": 379.58, "count": "25" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 133.92, "10th_percentile": 116.48, "90th_percentile": 133.92, "count": "51" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 133.92, "10th_percentile": 116.48, "90th_percentile": 133.92, "count": "38" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 133.92, "10th_percentile": 116.48, "90th_percentile": 133.92, "count": "19" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 282.1, "10th_percentile": 119.42, "90th_percentile": 321.41, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 131.04, "10th_percentile": 131.04, "90th_percentile": 150.66, "count": "22" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 491.39 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 523.13 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 126.24, "10th_percentile": 126.24, "90th_percentile": 145.14, "count": "17" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 471.31 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.1, "median_amount": 298.48, "10th_percentile": 298.48, "90th_percentile": 612.74, "count": "16" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 291.6, "10th_percentile": 291.6, "90th_percentile": 328.94, "count": "12" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 79.93, "median_amount": 334.51, "10th_percentile": 334.51, "90th_percentile": 334.51, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 133.92, "10th_percentile": 116.48, "90th_percentile": 200.18, "count": "40" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 149.01, "10th_percentile": 149.01, "90th_percentile": 149.01, "count": "1 through 10" } ] } ] }, { "description": "HC TRIIODOTHYRONINE TOTAL ASSAY, TT-3", "code_information": [ { "code": "84480", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 194.38, "discounted_cash": 56.0, "minimum": 14.18, "maximum": 176.3027, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 55.98, "10th_percentile": 55.98, "90th_percentile": 55.98, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 117.02 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 143.39 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 53.93, "10th_percentile": 53.93, "90th_percentile": 53.93, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 114.71 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 143.39 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 143.39 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 99.05, "10th_percentile": 99.05, "90th_percentile": 99.05, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 122.22, "10th_percentile": 122.22, "90th_percentile": 122.22, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 131.46 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 155.5, "10th_percentile": 155.5, "90th_percentile": 155.5, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 155.5, "10th_percentile": 155.5, "90th_percentile": 155.5, "count": "14" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 49.76, "10th_percentile": 49.76, "90th_percentile": 52.87, "count": "16" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 141.04, "10th_percentile": 141.04, "90th_percentile": 141.04, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 49.76, "10th_percentile": 49.76, "90th_percentile": 49.76, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 52.87, "10th_percentile": 52.87, "90th_percentile": 52.87, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 49.76, "10th_percentile": 49.76, "90th_percentile": 52.87, "count": "1 through 10" } ] } ] }, { "description": "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": 1.5435, "maximum": 7.51, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 124.7, "10th_percentile": 124.7, "90th_percentile": 124.7, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7.51 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2.3 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.84 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2.3 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2.3 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.54 } ] } ] }, { "description": "OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH CC", "code_information": [ { "code": "844", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8294.0, "minimum": 8294.44, "maximum": 14351.9, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14351.9 } ] } ] }, { "description": "HC (SUP SHELL A6220) GAUZE >16 <=48 SQ IN W/BORDR - A6220 - RU272047", "code_information": [ { "code": "A6220", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 3.69, "maximum": 3.69, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3.69, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC IMMUNFIX E-PHORSIS/URINE/CSF", "code_information": [ { "code": "86335", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 272.19, "discounted_cash": 78.0, "minimum": 29.35, "maximum": 272.19, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 242.24 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 272.19 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 237.46 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 272.19 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 272.19 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 272.09 }, { "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" } ] } ] }, { "description": "HC IADNA HEPATITIS C QUANT & REVERSE TRANSCRIPTION", "code_information": [ { "code": "87522", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 593.13, "discounted_cash": 172.0, "minimum": 42.84, "maximum": 537.9689, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 353.01, "10th_percentile": 353.01, "90th_percentile": 364.42, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 353.54 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 433.21 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 346.57 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 433.21 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 433.21 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 269.77, "10th_percentile": 269.77, "90th_percentile": 269.77, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 397.15 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 474.5, "10th_percentile": 423.5, "90th_percentile": 474.5, "count": "26" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 151.84, "10th_percentile": 143.28, "90th_percentile": 151.84, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 430.37, "10th_percentile": 430.37, "90th_percentile": 430.37, "count": "1 through 10" } ] } ] }, { "description": "HEADACHES WITHOUT MCC", "code_information": [ { "code": "103", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5156.0, "minimum": 5156.0, "maximum": 9859.12, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9859.12 } ] } ] }, { "description": "HC (SUP SHELL A6203) COMPOSITE DRSG <= 16 SQ IN - A6203 - 27200115", "code_information": [ { "code": "A6203", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 4.8, "maximum": 4.8, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC ASPERGILLUS ANTIBODY", "code_information": [ { "code": "86606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 261.56, "discounted_cash": 75.0, "minimum": 15.05, "maximum": 237.2349, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 121.65 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 149.07 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 119.26 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 149.07 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 149.07 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 139.52 }, { "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" } ] } ] }, { "description": "OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC", "code_information": [ { "code": "091", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9863.0, "minimum": 9863.66, "maximum": 48775.7039, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 9863.66, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 57504.94, "10th_percentile": 57504.94, "90th_percentile": 84290.67, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20703.81 } ] } ] }, { "description": "Trastuzumab-anns For IV Soln 420 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "55513013201", "type": "NDC" }, { "code": "Q5117", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 87.9165, "maximum": 131.12, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 131.12 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 104.89 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 131.12 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 131.12 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 87.92 } ] } ] }, { "description": "HC CT ANGIOGRAPHY CORO/HEART 3D", "code_information": [ { "code": "75574", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1814.06, "discounted_cash": 526.0, "minimum": 526.0774, "maximum": 1814.06, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1333.57 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1066.85 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1333.57 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1333.57 }, { "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": 1814.06 } ] } ] }, { "description": "HC IMMUNOASSAY ANALYTE QUAL/SEMIQUAL MULTIPLE STEP", "code_information": [ { "code": "83516", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 183.13, "discounted_cash": 53.0, "minimum": 11.53, "maximum": 166.0989, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 109.73, "10th_percentile": 104.89, "90th_percentile": 244.13, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 115.89 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 92.71 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 115.89 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 115.89 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 93.32, "10th_percentile": 93.32, "90th_percentile": 93.32, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 106.89 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY BYPASS WITH PTCA WITHOUT MCC", "code_information": [ { "code": "232", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16813.0, "minimum": 16813.05, "maximum": 71471.87, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 71471.87 } ] } ] }, { "description": "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": 196.0, "minimum": 152.2912, "maximum": 614.7737, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 209.16 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 167.33 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 209.16 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 209.16 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 152.29 } ] } ] }, { "description": "HC (SUP SHELL A6209) FOAM DRSG <=16 SQ IN W/O BDR", "code_information": [ { "code": "A6209", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 10.65, "maximum": 10.65, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 10.65, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC DETECT AGENT NOS DNA QUANT", "code_information": [ { "code": "87799", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1463.75, "discounted_cash": 424.0, "minimum": 42.84, "maximum": 1327.6212, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 421.56, "10th_percentile": 421.56, "90th_percentile": 421.56, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 353.54 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 433.21 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 346.57 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 433.21 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 433.21 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 397.15 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% 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", "minimum": 1.79, "maximum": 1.79, "payers_information": [ { "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" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC", "code_information": [ { "code": "281", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5156.0, "minimum": 5156.0, "maximum": 10835.25, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10835.25 } ] } ] }, { "description": "HC LEUKOCYTE (WBC) COUNT", "code_information": [ { "code": "85048", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 72.5, "discounted_cash": 21.0, "minimum": 2.54, "maximum": 65.7575, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 20.97 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.7 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 20.56 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 25.7 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 25.7 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.55 }, { "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" } ] } ] }, { "description": "HC MRI SPECTROSCOPY", "code_information": [ { "code": "76390", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2410.94, "discounted_cash": 699.0, "minimum": 699.1726, "maximum": 2410.94, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1941.32 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1553.05 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1941.32 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1941.32 }, { "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": 2410.94 } ] } ] }, { "description": "HC X-RAY SHOULDER 1 VW", "code_information": [ { "code": "73020", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 439.38, "discounted_cash": 127.0, "minimum": 61.5, "maximum": 398.5177, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 62.74 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 76.87 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 61.5 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 76.87 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 76.87 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 121.22 } ] } ] }, { "description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH CC", "code_information": [ { "code": "565", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7397.0, "minimum": 7397.74, "maximum": 38712.852, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 7397.74, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 7799.68, "10th_percentile": 7799.68, "90th_percentile": 7799.68, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11487.18 } ] } ] }, { "description": "HC XRAY HIP W PELVIS, UNILAT 2-3 VW", "code_information": [ { "code": "73502", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 431.25, "discounted_cash": 125.0, "minimum": 125.0625, "maximum": 391.1438, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 252.26, "10th_percentile": 252.26, "90th_percentile": 252.26, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 124.2, "10th_percentile": 124.2, "90th_percentile": 124.2, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 212.46, "10th_percentile": 176.74, "90th_percentile": 220.94, "count": "18" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 119.65, "10th_percentile": 112.88, "90th_percentile": 119.65, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 207.34, "10th_percentile": 207.34, "90th_percentile": 219.77, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 271.17, "10th_percentile": 260.76, "90th_percentile": 271.17, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 312.98 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 110.4, "10th_percentile": 104.16, "90th_percentile": 220.59, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 102.25, "10th_percentile": 102.25, "90th_percentile": 102.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 345.0, "10th_percentile": 325.5, "90th_percentile": 345.0, "count": "31" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 110.4, "10th_percentile": 104.16, "90th_percentile": 110.4, "count": "34" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 260.17, "10th_percentile": 260.17, "90th_percentile": 312.91, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 110.4, "10th_percentile": 104.16, "90th_percentile": 120.44, "count": "27" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 110.4, "10th_percentile": 110.4, "90th_percentile": 110.67, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 110.4, "10th_percentile": 104.16, "90th_percentile": 110.67, "count": "13" } ] } ] }, { "description": "HIV WITH MAJOR RELATED CONDITION WITH CC", "code_information": [ { "code": "975", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8742.0, "minimum": 8742.79, "maximum": 15266.73, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15266.73 } ] } ] }, { "description": "HC ESOPHAGRAM", "code_information": [ { "code": "74220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1179.69, "discounted_cash": 342.0, "minimum": 247.38, "maximum": 1069.9788, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 252.36 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 309.23 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 247.38 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 309.23 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 309.23 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 586.49 } ] } ] }, { "description": "HC IADNA DNA/RNA RSV AMPLIFIED PROBE TECHNIQUE", "code_information": [ { "code": "87634", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 264.69, "discounted_cash": 76.0, "minimum": 70.2, "maximum": 264.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 143.02, "10th_percentile": 143.02, "90th_percentile": 143.02, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 264.69 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 264.69 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 264.69 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 264.69 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 163.79, "10th_percentile": 163.79, "90th_percentile": 163.79, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 264.69 }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 211.75, "10th_percentile": 199.75, "90th_percentile": 211.75, "count": "22" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 159.66, "10th_percentile": 159.66, "90th_percentile": 159.66, "count": "1 through 10" } ] } ] }, { "description": "HC BLOOD CLOT FACTOR VIII TEST, RELATED ANTIGEN", "code_information": [ { "code": "85244", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 355.0, "discounted_cash": 102.0, "minimum": 20.42, "maximum": 321.985, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 168.52 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 206.49 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 165.2 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 206.49 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 206.49 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 189.3 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 20.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 284.0, "10th_percentile": 284.0, "90th_percentile": 284.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 90.88, "10th_percentile": 90.88, "90th_percentile": 90.88, "count": "1 through 10" } ] } ] }, { "description": "OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH CC", "code_information": [ { "code": "155", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6276.0, "minimum": 6276.87, "maximum": 10804.6, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10804.6 } ] } ] }, { "description": "PNEUMOTHORAX WITHOUT CCMCC", "code_information": [ { "code": "201", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5156.0, "minimum": 5156.0, "maximum": 15892.929, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8430.3 } ] } ] }, { "description": "HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "969", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 26228.0, "minimum": 26228.36, "maximum": 72163.88, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 72163.88 } ] } ] }, { "description": "HC CT SCAN CERV SPINE CONTRAST", "code_information": [ { "code": "72126", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3257.5, "discounted_cash": 944.0, "minimum": 650.0, "maximum": 2954.5525, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1383.58 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1106.86 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1383.58 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1383.58 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 981.29 } ] } ] }, { "description": "HC OFFICE/OUTPATIENT ESTABLISHED MINIMAL PROBLEM(S) - 99211 - 76100006", "code_information": [ { "code": "99211", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 137.5, "discounted_cash": 39.0, "minimum": 39.875, "maximum": 124.7125, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 37.4, "10th_percentile": 37.4, "90th_percentile": 37.4, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 15.27, "10th_percentile": 15.27, "90th_percentile": 15.27, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 37.4, "10th_percentile": 37.4, "90th_percentile": 37.4, "count": "1 through 10" } ] } ] }, { "description": "HC X-RAY RIBS, CHEST 3+ VW", "code_information": [ { "code": "71101", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 773.75, "discounted_cash": 224.0, "minimum": 101.55, "maximum": 701.7912, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 210.24, "10th_percentile": 210.24, "90th_percentile": 222.84, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 103.59 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 126.93 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 202.53, "10th_percentile": 202.53, "90th_percentile": 214.67, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 101.55 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 126.93 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 126.93 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 250.97 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 198.08, "10th_percentile": 198.08, "90th_percentile": 198.56, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 619.0, "10th_percentile": 584.0, "90th_percentile": 619.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 198.08, "10th_percentile": 198.08, "90th_percentile": 198.56, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 198.08, "10th_percentile": 186.88, "90th_percentile": 216.08, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 186.88, "10th_percentile": 186.88, "90th_percentile": 186.88, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 198.08, "10th_percentile": 198.08, "90th_percentile": 198.08, "count": "1 through 10" } ] } ] }, { "description": "HC ASSAY OF CALCIUM, TOTAL", "code_information": [ { "code": "82310", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 36.25, "discounted_cash": 10.0, "minimum": 5.16, "maximum": 36.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 20.76, "10th_percentile": 20.76, "90th_percentile": 20.76, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 10.44, "10th_percentile": 10.44, "90th_percentile": 10.44, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 36.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 36.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 10.06, "10th_percentile": 10.06, "90th_percentile": 10.06, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 36.25 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 36.25 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 36.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 29.0, "10th_percentile": 29.0, "90th_percentile": 29.0, "count": "1 through 10" }, { "payer_name": "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 29.0, "10th_percentile": 29.0, "90th_percentile": 29.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 9.28, "10th_percentile": 9.28, "90th_percentile": 9.28, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 26.3, "10th_percentile": 26.3, "90th_percentile": 26.3, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 9.28, "10th_percentile": 9.28, "90th_percentile": 9.28, "count": "11" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 9.28, "10th_percentile": 9.28, "90th_percentile": 9.28, "count": "1 through 10" } ] } ] }, { "description": "HC NM RENAL FLOW/FUNCT IMAGE,PHARM RX", "code_information": [ { "code": "78708", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1485.31, "discounted_cash": 430.0, "minimum": 430.7399, "maximum": 1347.1762, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 528.1 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 647.11 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 517.68 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 647.11 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 647.11 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1015.09 } ] } ] }, { "description": "HC CT NECK TISSUE COMBO", "code_information": [ { "code": "70492", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3603.13, "discounted_cash": 1044.0, "minimum": 650.0, "maximum": 3268.0389, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1642.8 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1314.23 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1642.8 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1642.8 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1280.2 } ] } ] }, { "description": "HC (SUP SHELL A4411) OST SKN BARR EXTND =4SQ", "code_information": [ { "code": "A4411", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 7.26, "maximum": 7.26, "payers_information": [ { "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" } ] } ] }, { "description": "SIGNS AND SYMPTOMS WITHOUT MCC", "code_information": [ { "code": "948", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5828.0, "minimum": 5828.52, "maximum": 26290.1598, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "other", "standard_charge_dollar": 6090.81, "standard_charge_algorithm": "2342.62 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 6481.99, "10th_percentile": 3762.12, "90th_percentile": 531182.23, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 5828.52, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 11699.52, "10th_percentile": 3899.84, "90th_percentile": 29248.8, "count": "23" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "other", "standard_charge_dollar": 5828.52, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 22397.42, "10th_percentile": 22397.42, "90th_percentile": 79250.0, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9437.08 } ] } ] }, { "description": "HC (SUP SHELL Q4104) INTEGRA BMWD PER SQ CM", "code_information": [ { "code": "Q4104", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 156.8385, "maximum": 588.64, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 588.64 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 233.9 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 187.12 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 233.9 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 233.9 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 156.84 } ] } ] }, { "description": "HC CMV ANTIBODY, IGM", "code_information": [ { "code": "86645", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 362.81, "discounted_cash": 105.0, "minimum": 16.85, "maximum": 329.0687, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 117.98 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 144.57 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 115.65 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 144.57 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 144.57 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 156.21 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 92.88, "10th_percentile": 92.88, "90th_percentile": 92.88, "count": "1 through 10" } ] } ] }, { "description": "HC BLOOD SMEAR,MICRO EXAM,MANUAL DIFF WBC", "code_information": [ { "code": "85007", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 45.31, "discounted_cash": 13.0, "minimum": 3.8, "maximum": 41.0962, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 23.91 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 29.3 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 23.44 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 29.3 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 29.3 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.23 }, { "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" } ] } ] }, { "description": "OTHER CIRCULATORY SYSTEM O.R. PROCEDURES", "code_information": [ { "code": "264", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15019.0, "minimum": 15019.66, "maximum": 39382.27, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 39382.27 } ] } ] }, { "description": "HC MECHANICAL TRACTION THERAPY", "code_information": [ { "code": "97012", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 119.38, "discounted_cash": 34.0, "minimum": 13.76, "maximum": 108.2777, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Sulfamethoxazole-Trimethoprim IV Soln 400-80 MG/5ML", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "00703951401", "type": "NDC" }, { "code": "J2865", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC MAMMOGRAPHY; BILATERAL", "code_information": [ { "code": "77066", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 753.44, "discounted_cash": 218.0, "minimum": 101.51, "maximum": 753.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 170.91, "10th_percentile": 170.91, "90th_percentile": 170.91, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 492.1 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 603.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 164.65, "10th_percentile": 164.65, "90th_percentile": 164.65, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 482.39 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 603.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 603.0 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 302.42, "10th_percentile": 302.42, "90th_percentile": 302.42, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 373.15, "10th_percentile": 373.15, "90th_percentile": 380.32, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 753.44 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 161.42, "10th_percentile": 151.92, "90th_percentile": 318.5, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 101.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 103.23, "10th_percentile": 103.23, "90th_percentile": 103.23, "count": "15" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 151.92, "10th_percentile": 151.92, "90th_percentile": 161.42, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 175.66, "10th_percentile": 175.66, "90th_percentile": 430.6, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 151.92, "10th_percentile": 151.92, "90th_percentile": 151.92, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 151.92, "10th_percentile": 151.92, "90th_percentile": 151.92, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 151.92, "10th_percentile": 151.92, "90th_percentile": 151.92, "count": "1 through 10" } ] } ] }, { "description": "HC MRI UPPER EXTREM WO/W CONTRAST", "code_information": [ { "code": "73220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3405.31, "discounted_cash": 987.0, "minimum": 900.0, "maximum": 3088.6162, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2670.71 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2136.55 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2670.71 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2670.71 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2715.43 } ] } ] }, { "description": "OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "630", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4259.0, "minimum": 4259.31, "maximum": 17206.02, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17206.02 } ] } ] }, { "description": "HC (SUP SHELL L3807) WHF ORTHOS NO JNT PRFAB CUSTOM FIT", "code_information": [ { "code": "L3807", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 272.97, "maximum": 272.97, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 272.97, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "SIMPLE PNEUMONIA AND PLEURISY WITH MCC", "code_information": [ { "code": "193", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8742.0, "minimum": 8742.79, "maximum": 15495.44, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "other", "standard_charge_dollar": 8742.79, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 6431.46, "10th_percentile": 6431.46, "90th_percentile": 6431.46, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "other", "standard_charge_dollar": 9136.22, "standard_charge_algorithm": "2342.62 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 11933.43, "10th_percentile": 11933.43, "90th_percentile": 12590.95, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 8742.79, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 6431.46, "10th_percentile": 6167.61, "90th_percentile": 8575.28, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "other", "standard_charge_dollar": 8742.79, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 6720.0, "10th_percentile": 6720.0, "90th_percentile": 9840.0, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "other", "standard_charge_dollar": 8742.79, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 25714.23, "10th_percentile": 25714.23, "90th_percentile": 25714.23, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15495.44 } ] } ] }, { "description": "NORMAL NEWBORN", "code_information": [ { "code": "795", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6949.0, "minimum": 2355.44, "maximum": 7262.12, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2355.44 } ] } ] }, { "description": "Pamidronate Disodium IV Soln 3 MG/ML", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "67457043010", "type": "NDC" }, { "code": "J2430", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 43.722, "maximum": 147.72, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 147.72 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 65.21 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 52.16 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 65.21 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 65.21 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 43.72 } ] } ] }, { "description": "Phenytoin Sodium Inj 50 MG/ML", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "00641049321", "type": "NDC" }, { "code": "J1165", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.638, "maximum": 8.82, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.82 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2.44 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.95 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2.44 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2.44 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.64 } ] } ] }, { "description": "HC ASSAY OF ACTH", "code_information": [ { "code": "82024", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 574.38, "discounted_cash": 166.0, "minimum": 38.62, "maximum": 520.9627, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 165.42, "10th_percentile": 165.42, "90th_percentile": 165.42, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 318.83 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 390.68 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 312.55 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 390.68 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 390.68 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 358.03 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 459.5, "10th_percentile": 459.5, "90th_percentile": 459.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 147.04, "10th_percentile": 147.04, "90th_percentile": 147.04, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 416.77, "10th_percentile": 416.77, "90th_percentile": 416.77, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 147.04, "10th_percentile": 62.42, "90th_percentile": 147.04, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 147.04, "10th_percentile": 147.04, "90th_percentile": 147.04, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 147.04, "10th_percentile": 147.04, "90th_percentile": 147.04, "count": "1 through 10" } ] } ] }, { "description": "MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH CC", "code_information": [ { "code": "723", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7621.0, "minimum": 7621.92, "maximum": 13471.27, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13471.27 } ] } ] }, { "description": "MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "761", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3810.0, "minimum": 3810.96, "maximum": 6725.61, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6725.61 } ] } ] }, { "description": "HC (SUP SHELL A6407) PACKING STRIPS, NON-IMPREG - A6407 - 27200155", "code_information": [ { "code": "A6407", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2.66, "maximum": 2.66, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2.66, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6154) WOUND POUCH EACH", "code_information": [ { "code": "A6154", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 20.49, "maximum": 20.49, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 20.49, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC CT ANGIO,UPPER EXTREM,COMBO", "code_information": [ { "code": "73206", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2101.25, "discounted_cash": 609.0, "minimum": 609.3625, "maximum": 1905.8338, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1744.7 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1395.75 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1744.7 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1744.7 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1869.49 } ] } ] }, { "description": "HC SYPHILIS TEST, QUANTITATIVE", "code_information": [ { "code": "86593", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 82.19, "discounted_cash": 23.0, "minimum": 4.4, "maximum": 74.5463, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 36.35 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 44.54 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 35.63 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 44.54 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 44.54 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.79 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 4.4, "10th_percentile": 4.4, "90th_percentile": 4.4, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 19.84, "10th_percentile": 19.84, "90th_percentile": 19.84, "count": "1 through 10" } ] } ] }, { "description": "Promethazine HCl Tab 25 MG", "drug_information": { "unit": 100.0, "type": "EA" }, "code_information": [ { "code": "00904730461", "type": "NDC" }, { "code": "Q0169", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC CELL COUNT,MISC BODY FLUIDS", "code_information": [ { "code": "89050", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 165.63, "discounted_cash": 48.0, "minimum": 4.72, "maximum": 150.2264, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 39.01 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 47.8 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 38.24 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 47.8 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 47.8 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 43.76 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 40.0, "10th_percentile": 40.0, "90th_percentile": 80.0, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL A4620) VARIABLE CONCENTRATION MASK", "code_information": [ { "code": "A4620", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "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" } ] } ] }, { "description": "MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "830", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4707.0, "minimum": 4707.65, "maximum": 17742.41, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17742.41 } ] } ] }, { "description": "HC HPYLORI STOOL EIA", "code_information": [ { "code": "87338", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 506.25, "discounted_cash": 146.0, "minimum": 14.38, "maximum": 459.1687, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 94.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 116.1 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 92.88 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 116.1 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 116.1 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 133.31 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.38, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC VENOUS SAMPLING BY CATHETER", "code_information": [ { "code": "75893", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1848.44, "discounted_cash": 536.0, "minimum": 536.0476, "maximum": 1676.5351, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 843.2 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1033.21 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 826.56 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1033.21 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1033.21 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 676.77 } ] } ] }, { "description": "HC (SUP SHELL A4334) URINARY CATH LEG STRAP - A4334 - 27100023", "code_information": [ { "code": "A4334", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 7.01, "maximum": 7.01, "payers_information": [ { "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" } ] } ] }, { "description": "BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC", "code_information": [ { "code": "095", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12553.0, "minimum": 12553.74, "maximum": 30406.14, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30406.14 } ] } ] }, { "description": "HC SMEAR,INCLUSION BODIES/PARASITES,INTERP", "code_information": [ { "code": "87207", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 94.38, "discounted_cash": 27.0, "minimum": 5.99, "maximum": 85.6027, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 51.02, "10th_percentile": 51.02, "90th_percentile": 51.02, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 49.46 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 60.61 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 48.49 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 60.61 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 60.61 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 55.53 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 89.5, "10th_percentile": 89.5, "90th_percentile": 89.5, "count": "1 through 10" } ] } ] }, { "description": "INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC", "code_information": [ { "code": "021", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10984.0, "minimum": 10984.53, "maximum": 62408.5, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 62408.5 } ] } ] }, { "description": "HC JAK2 GENE", "code_information": [ { "code": "81270", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1830.63, "discounted_cash": 530.0, "minimum": 91.66, "maximum": 1660.3814, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 145.23 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 177.95 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 142.36 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 177.95 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 177.95 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 849.73 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 91.66, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC ELEC STIM OTHER THAN WOUND - G0283 - 42000014", "code_information": [ { "code": "G0283", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 80.63, "minimum": 12.06, "maximum": 80.63, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 80.63 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.06, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC INSITU HYBRIDIZE, PER SPCMN, INIT SING PROB STAIN", "code_information": [ { "code": "88365", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 400.0, "discounted_cash": 116.0, "minimum": 116.0, "maximum": 400.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 400.0 } ] } ] }, { "description": "HC HLA TYPING DR/DQ", "code_information": [ { "code": "86817", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 859.06, "discounted_cash": 249.0, "minimum": 106.14, "maximum": 859.06, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 531.39 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 651.14 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 520.91 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 651.14 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 651.14 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 859.06 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 106.14, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL Q4116) ALLODERM", "code_information": [ { "code": "Q4116", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 97.9965, "maximum": 457.26, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 457.26 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 98.0 } ] } ] }, { "description": "HC VENOGRAM HEPATIC W HEMODYNAMICS", "code_information": [ { "code": "75889", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9392.5, "discounted_cash": 2723.0, "minimum": 611.8963, "maximum": 8518.9975, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 844.66 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1035.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 827.99 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1035.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1035.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 611.9 } ] } ] }, { "description": "HC IMMUNOFLUOR ANTB 1ST STAIN", "code_information": [ { "code": "88346", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 162.5, "discounted_cash": 47.0, "minimum": 47.125, "maximum": 162.5, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 162.5 } ] } ] }, { "description": "HC TEAM CONFERENCE FACE-TO-FACE NONPHYSICIAN", "code_information": [ { "code": "99366", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 169.69, "discounted_cash": 49.0, "minimum": 49.2101, "maximum": 153.9088, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC", "code_information": [ { "code": "393", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9415.0, "minimum": 9415.31, "maximum": 18854.12, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18854.12 } ] } ] }, { "description": "INTERSTITIAL LUNG DISEASE WITHOUT CCMCC", "code_information": [ { "code": "198", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4931.0, "minimum": 4931.83, "maximum": 8443.27, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8443.27 } ] } ] }, { "description": "RECTAL RESECTION WITH MCC", "code_information": [ { "code": "332", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14347.0, "minimum": 14347.14, "maximum": 42684.36, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 42684.36 } ] } ] }, { "description": "ACUTE MAJOR EYE INFECTIONS WITH CCMCC", "code_information": [ { "code": "121", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9191.0, "minimum": 9191.13, "maximum": 13714.12, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13714.12 } ] } ] }, { "description": "HC ASSAY OF GGT", "code_information": [ { "code": "82977", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 150.94, "discounted_cash": 43.0, "minimum": 7.2, "maximum": 136.9026, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 86.46, "10th_percentile": 86.46, "90th_percentile": 86.46, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 43.47, "10th_percentile": 43.47, "90th_percentile": 43.47, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 59.41 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 72.8 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 41.88, "10th_percentile": 41.88, "90th_percentile": 41.88, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 58.24 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 72.8 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 72.8 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 76.92, "10th_percentile": 76.92, "90th_percentile": 76.92, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 66.75 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 120.75, "10th_percentile": 120.75, "90th_percentile": 120.75, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 120.75, "10th_percentile": 120.75, "90th_percentile": 120.75, "count": "13" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 38.64, "10th_percentile": 38.64, "90th_percentile": 38.64, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 41.06, "10th_percentile": 41.06, "90th_percentile": 41.06, "count": "1 through 10" } ] } ] }, { "description": "HC ASSAY OF FETAL FIBRONECTIN", "code_information": [ { "code": "82731", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1165.0, "discounted_cash": 337.0, "minimum": 64.41, "maximum": 1056.655, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 531.62 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 651.42 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 521.13 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 651.42 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 651.42 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 597.11 }, { "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" } ] } ] }, { "description": "HC VENOGRAM EXTREM BILAT", "code_information": [ { "code": "75822", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3313.44, "discounted_cash": 960.0, "minimum": 360.39, "maximum": 3005.2901, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 367.64 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 450.49 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 360.39 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 450.49 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 450.49 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 555.49 } ] } ] }, { "description": "HC EVAL OF BRONCHOSPASM", "code_information": [ { "code": "94060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 576.88, "discounted_cash": 167.0, "minimum": 167.2952, "maximum": 523.2302, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 166.14, "10th_percentile": 158.22, "90th_percentile": 166.14, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 295.55, "10th_percentile": 278.7, "90th_percentile": 295.55, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 160.05, "10th_percentile": 152.42, "90th_percentile": 160.05, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.1, "median_amount": 350.14, "10th_percentile": 350.14, "90th_percentile": 350.14, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 342.07, "10th_percentile": 342.07, "90th_percentile": 352.08, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 79.93, "median_amount": 368.88, "10th_percentile": 368.88, "90th_percentile": 368.88, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 461.5, "10th_percentile": 427.0, "90th_percentile": 461.5, "count": "17" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 147.68, "10th_percentile": 136.64, "90th_percentile": 147.68, "count": "15" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 418.58, "10th_percentile": 341.3, "90th_percentile": 418.58, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 29.54, "10th_percentile": 25.0, "90th_percentile": 136.64, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 147.68, "10th_percentile": 147.68, "90th_percentile": 147.68, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 147.68, "10th_percentile": 145.18, "90th_percentile": 147.68, "count": "1 through 10" } ] } ] }, { "description": "HC CRITICAL CARE, ADDL 30 MIN", "code_information": [ { "code": "99292", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1330.0, "discounted_cash": 385.0, "minimum": 385.7, "maximum": 1206.31, "payers_information": [ { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 3706.09, "10th_percentile": 3706.09, "90th_percentile": 3706.09, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 8512.0, "10th_percentile": 8512.0, "90th_percentile": 8512.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 1480.4, "10th_percentile": 1480.4, "90th_percentile": 2042.88, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 680.96, "10th_percentile": 680.96, "90th_percentile": 2368.64, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 340.48, "10th_percentile": 340.48, "90th_percentile": 2368.64, "count": "1 through 10" } ] } ] }, { "description": "Luspatercept-aamt For Subcutaneous Inj 75 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "59572077501", "type": "NDC" }, { "code": "J0896", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 129.906, "maximum": 193.74, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 193.74 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 154.99 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 193.74 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 193.74 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 129.91 } ] } ] }, { "description": "HC T CELL ABSOLUTE COUNT", "code_information": [ { "code": "86361", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 317.19, "discounted_cash": 91.0, "minimum": 26.78, "maximum": 287.6913, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 90.79 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 111.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 89.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 111.25 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 111.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 248.26 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 26.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 212.75, "10th_percentile": 212.75, "90th_percentile": 212.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 68.08, "10th_percentile": 68.08, "90th_percentile": 68.08, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 64.24, "10th_percentile": 64.24, "90th_percentile": 68.08, "count": "1 through 10" } ] } ] }, { "description": "HC IRRIG IMPLANTED DRUG DELIVERY DEVICE", "code_information": [ { "code": "96523", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 413.44, "discounted_cash": 119.0, "minimum": 119.8976, "maximum": 374.9901, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 191.89, "10th_percentile": 191.89, "90th_percentile": 191.89, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 99.96, "10th_percentile": 98.8, "90th_percentile": 99.96, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 308.75, "10th_percentile": 294.0, "90th_percentile": 308.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 94.08, "10th_percentile": 94.08, "90th_percentile": 98.8, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 98.8, "10th_percentile": 94.08, "90th_percentile": 280.04, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 98.8, "10th_percentile": 94.08, "90th_percentile": 99.96, "count": "1 through 10" } ] } ] }, { "description": "Prochlorperazine Edisylate Inj 10 MG/2ML", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "23155029431", "type": "NDC" }, { "code": "J0780", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 9.198, "maximum": 147.72, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 32.74, "10th_percentile": 32.74, "90th_percentile": 32.74, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 147.72 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.72 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 10.97 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 13.72 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 13.72 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.2 } ] } ] }, { "description": "Fentanyl Citrate Preservative Free (PF) Inj 100 MCG/2ML", "drug_information": { "unit": 20.0, "type": "ML" }, "code_information": [ { "code": "00409909416", "type": "NDC" }, { "code": "J3010", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2.646, "maximum": 8.82, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 12.77, "10th_percentile": 12.77, "90th_percentile": 13.54, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.82 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.95 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3.16 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 3.95 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 3.95 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2.65 } ] } ] }, { "description": "HC (SUP SHELL Q4158) KERECIS OMEGA3, PER SQ CM", "code_information": [ { "code": "Q4158", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 200.403, "maximum": 862.64, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 862.64 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 298.87 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 239.1 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 298.87 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 298.87 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 200.4 } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITH CC", "code_information": [ { "code": "348", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6949.0, "minimum": 6949.39, "maximum": 15429.42, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15429.42 } ] } ] }, { "description": "OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC", "code_information": [ { "code": "144", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6276.0, "minimum": 6276.87, "maximum": 20429.12, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20429.12 } ] } ] }, { "description": "PREMATURITY WITH MAJOR PROBLEMS", "code_information": [ { "code": "791", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 29815.0, "minimum": 29815.14, "maximum": 47851.47, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 47851.47 } ] } ] }, { "description": "HC (SUP SHELL Q4201) MATRION 1 SQ CM", "code_information": [ { "code": "Q4201", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 272.0025, "maximum": 405.66, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 405.66 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 324.52 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 405.66 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 405.66 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 272.0 } ] } ] }, { "description": "HC (SUP SHELL L3762) EO RIGID W/O JOINTS PRE OTS", "code_information": [ { "code": "L3762", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 117.38, "maximum": 117.38, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 117.38, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY AC JTS", "code_information": [ { "code": "73050", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 594.69, "discounted_cash": 172.0, "minimum": 98.69, "maximum": 539.3838, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 100.68 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 123.36 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 98.69 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 123.36 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 123.36 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 169.16 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 448.75, "10th_percentile": 448.75, "90th_percentile": 448.75, "count": "1 through 10" } ] } ] }, { "description": "HC X-RAY KNEE 1 OR 2 VIEW", "code_information": [ { "code": "73560", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 219.38, "discounted_cash": 63.0, "minimum": 63.6202, "maximum": 219.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 118.5, "10th_percentile": 118.5, "90th_percentile": 118.5, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 59.58, "10th_percentile": 59.58, "90th_percentile": 63.18, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 77.3 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 94.72 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 60.86, "10th_percentile": 57.4, "90th_percentile": 60.86, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 75.77 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 94.72 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 94.72 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 111.79, "10th_percentile": 111.79, "90th_percentile": 111.79, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 137.94, "10th_percentile": 132.58, "90th_percentile": 137.94, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 219.38 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 56.16, "10th_percentile": 52.96, "90th_percentile": 175.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 175.5, "10th_percentile": 165.5, "90th_percentile": 175.5, "count": "20" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 56.16, "10th_percentile": 52.96, "90th_percentile": 56.16, "count": "16" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 159.18, "10th_percentile": 159.18, "90th_percentile": 159.18, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 56.16, "10th_percentile": 56.16, "90th_percentile": 56.16, "count": "13" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 52.96, "10th_percentile": 52.96, "90th_percentile": 56.27, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 56.16, "10th_percentile": 56.16, "90th_percentile": 56.27, "count": "1 through 10" } ] } ] }, { "description": "PANCREAS, LIVER AND SHUNT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "407", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7173.0, "minimum": 7173.57, "maximum": 26166.82, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26166.82 } ] } ] }, { "description": "KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CCMCC", "code_information": [ { "code": "661", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4035.0, "minimum": 4035.13, "maximum": 12206.31, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12206.31 } ] } ] }, { "description": "HC 3D RENDERING W/INTERP&POSTPROC DIFF WORK STATIO", "code_information": [ { "code": "76377", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1009.06, "discounted_cash": 292.0, "minimum": 286.0, "maximum": 915.2174, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 291.76 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 357.51 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 286.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 357.51 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 357.51 }, { "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": 343.99 } ] } ] }, { "description": "Ibutilide Fumarate Inj 1 MG/10ML", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "00009379401", "type": "NDC" }, { "code": "J1742", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 645.939, "maximum": 4389.55, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4389.55 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1459.18 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1167.33 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1459.18 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1459.18 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 645.94 } ] } ] }, { "description": "CERVICAL SPINAL FUSION WITHOUT CCMCC", "code_information": [ { "code": "473", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3586.0, "minimum": 3586.78, "maximum": 28780.44, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28780.44 } ] } ] }, { "description": "HC MRI PELVIS W/CONTRAST", "code_information": [ { "code": "72196", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2698.75, "discounted_cash": 782.0, "minimum": 782.6375, "maximum": 2447.7663, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2118.32 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1694.64 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2118.32 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2118.32 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1652.39 } ] } ] }, { "description": "HC (SUP SHELL A4565) SLINGS - A4565 - 27100006", "code_information": [ { "code": "A4565", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 10.98, "maximum": 10.98, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 10.98, "additional_payer_notes": "100.00% 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": 258.0, "minimum": 258.5524, "maximum": 891.56, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 656.73 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 804.72 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 643.77 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 804.72 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 804.72 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 891.56 } ] } ] }, { "description": "HC X-RAY WRIST 3+ VW", "code_information": [ { "code": "73110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 487.81, "discounted_cash": 141.0, "minimum": 97.22, "maximum": 442.4437, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 285.39, "10th_percentile": 285.39, "90th_percentile": 299.71, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 140.49, "10th_percentile": 132.57, "90th_percentile": 280.98, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 99.18 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 121.53 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 127.71, "10th_percentile": 127.71, "90th_percentile": 270.68, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 97.22 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 121.53 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 121.53 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 390.25, "10th_percentile": 390.25, "90th_percentile": 390.25, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 295.01, "10th_percentile": 295.01, "90th_percentile": 306.74, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 279.18 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 237.0, "10th_percentile": 124.88, "90th_percentile": 368.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 390.25, "10th_percentile": 368.25, "90th_percentile": 390.25, "count": "89" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 124.88, "10th_percentile": 124.88, "90th_percentile": 124.88, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 337.32, "10th_percentile": 294.34, "90th_percentile": 353.96, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 124.88, "10th_percentile": 117.84, "90th_percentile": 136.25, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 124.88, "10th_percentile": 117.84, "90th_percentile": 125.21, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 124.88, "10th_percentile": 124.88, "90th_percentile": 125.21, "count": "1 through 10" } ] } ] }, { "description": "UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "741", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3362.0, "minimum": 3362.61, "maximum": 16812.26, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16812.26 } ] } ] }, { "description": "HC HEP C ANTIBODY, HIGH RISK - G0472 - 30200256", "code_information": [ { "code": "G0472", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 264.06, "minimum": 46.35, "maximum": 264.06, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 109.72 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 87.78 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 109.72 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 109.72 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 264.06 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 46.35, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT CCMCC", "code_information": [ { "code": "759", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5380.0, "minimum": 5380.18, "maximum": 7823.17, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7823.17 } ] } ] }, { "description": "FRACTURES OF HIP AND PELVIS WITHOUT MCC", "code_information": [ { "code": "536", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6501.0, "minimum": 6501.05, "maximum": 9520.78, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9520.78 } ] } ] }, { "description": "HC ASSAY L/S RATIO", "code_information": [ { "code": "83661", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 316.88, "discounted_cash": 91.0, "minimum": 21.99, "maximum": 287.4102, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 181.41 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 222.29 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 177.83 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 222.29 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 222.29 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 203.86 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY MASTOIDS 3+ VW", "code_information": [ { "code": "70130", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 508.75, "discounted_cash": 147.0, "minimum": 145.88, "maximum": 461.4362, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 148.81 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 182.35 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 145.88 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 182.35 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 182.35 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 389.13 } ] } ] }, { "description": "HC TUMOR IMMUNOHISTOCHEM/MANUAL", "code_information": [ { "code": "88360", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 621.88, "discounted_cash": 180.0, "minimum": 180.3452, "maximum": 621.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 307.89, "10th_percentile": 307.89, "90th_percentile": 307.89, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 621.88 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 114.48, "10th_percentile": 114.48, "90th_percentile": 114.48, "count": "1 through 10" } ] } ] }, { "description": "Phytonadione Inj 1 MG/0.5ML (2 MG/ML)", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "76329124001", "type": "NDC" }, { "code": "J3430", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 7.7175, "maximum": 62.76, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 62.76 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.46 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9.17 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 11.46 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 11.46 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.72 } ] } ] }, { "description": "PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CCMCC", "code_information": [ { "code": "244", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4707.0, "minimum": 4707.65, "maximum": 21308.58, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21308.58 } ] } ] }, { "description": "VIRAL MENINGITIS WITHOUT CCMCC", "code_information": [ { "code": "076", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5828.0, "minimum": 5828.52, "maximum": 9728.27, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9728.27 } ] } ] }, { "description": "HC MICROBE SUSCEPT MACROBROTH", "code_information": [ { "code": "87188", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 62.81, "discounted_cash": 18.0, "minimum": 6.64, "maximum": 62.81, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 54.78 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 62.81 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 53.7 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 62.81 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 62.81 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 61.56 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6.64, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC MRI JOINT OF LEG W/CONTRAST", "code_information": [ { "code": "73722", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3321.88, "discounted_cash": 963.0, "minimum": 900.0, "maximum": 3012.9452, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2118.32 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1694.64 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2118.32 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2118.32 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2086.66 } ] } ] }, { "description": "HC QUANT DIFF PULM PRFUSION & VENT W/WO IMG", "code_information": [ { "code": "78598", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1392.81, "discounted_cash": 403.0, "minimum": 403.9149, "maximum": 1392.81, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1064.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1304.08 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1043.26 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1304.08 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1304.08 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1392.81 } ] } ] }, { "description": "HC (SUP SHELL L0174) CERV SR 2PC THOR EXT PRE OTS", "code_information": [ { "code": "L0174", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 420.89, "maximum": 420.89, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 420.89, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC SCREENING DIGITAL BREAST TOMOSYNTHESIS BILAT", "code_information": [ { "code": "77063", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 593.13, "discounted_cash": 172.0, "minimum": 21.51, "maximum": 537.9689, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 105.05 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 128.72 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 102.97 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 128.72 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 128.72 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 101.48 }, { "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" } ] } ] }, { "description": "HC ARC RBC PRETREATMENT,SERUM INHIB", "code_information": [ { "code": "86977", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 181.88, "discounted_cash": 52.0, "minimum": 52.7452, "maximum": 181.88, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 181.88 } ] } ] }, { "description": "HC ARTHROGRAM OF ELBOW", "code_information": [ { "code": "73085", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 952.5, "discounted_cash": 276.0, "minimum": 271.73, "maximum": 863.9175, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 277.2 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 339.66 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 271.73 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 339.66 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 339.66 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 631.63 } ] } ] }, { "description": "HC TRICHOMONAS VAGINALIS AMPLIF", "code_information": [ { "code": "87661", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 368.13, "discounted_cash": 106.0, "minimum": 35.09, "maximum": 333.8939, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 200.91 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 246.19 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 196.95 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 246.19 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 246.19 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 325.3 }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 294.5, "10th_percentile": 277.75, "90th_percentile": 294.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 102.77, "10th_percentile": 102.77, "90th_percentile": 102.77, "count": "1 through 10" } ] } ] }, { "description": "UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "743", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3362.0, "minimum": 3362.61, "maximum": 14626.59, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14626.59 } ] } ] }, { "description": "EPISTAXIS WITHOUT MCC", "code_information": [ { "code": "151", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4707.0, "minimum": 4707.65, "maximum": 8653.11, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8653.11 } ] } ] }, { "description": "HC (SUP SHELL L3332) SHOE LIFTS TAPERED TO ONE-HA", "code_information": [ { "code": "L3332", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 88.45, "maximum": 88.45, "payers_information": [ { "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" } ] } ] }, { "description": "MOUTH PROCEDURES WITH CCMCC", "code_information": [ { "code": "137", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7621.0, "minimum": 7621.92, "maximum": 17603.3, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17603.3 } ] } ] }, { "description": "HC X-RAY FISTULA,ABSCESS,SINUS TRACT", "code_information": [ { "code": "76080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 995.63, "discounted_cash": 288.0, "minimum": 141.59, "maximum": 903.0364, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 144.44 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 176.99 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 141.59 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 176.99 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 176.99 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 298.91 } ] } ] }, { "description": "HC ASSAY OF SOMATOSTATIN", "code_information": [ { "code": "84307", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 744.06, "discounted_cash": 215.0, "minimum": 18.28, "maximum": 674.8624, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 139.52 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 170.96 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 136.77 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 170.96 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 170.96 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 169.46 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18.28, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC TRANSCATHETER RX EMBOLIZATN", "code_information": [ { "code": "75894", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5074.06, "discounted_cash": 1471.0, "minimum": 1471.4774, "maximum": 5074.06, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3644.17 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4465.37 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3572.28 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 4465.37 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 4465.37 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5074.06 } ] } ] }, { "description": "HC PARTICLE AGGLUT ANTBDY TITR", "code_information": [ { "code": "86406", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 98.13, "discounted_cash": 28.0, "minimum": 10.64, "maximum": 98.13, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 87.79 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 98.13 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 86.06 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 98.13 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 98.13 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 98.13 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 10.64, "additional_payer_notes": "100.00% 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": "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" } ] } ] }, { "description": "HC ASSAY OF THYROXINE BNDNG GLOBULIN", "code_information": [ { "code": "84442", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 210.63, "discounted_cash": 61.0, "minimum": 14.78, "maximum": 191.0414, "payers_information": [ { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 149.55 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 149.55 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 137.02 }, { "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 Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 53.92, "10th_percentile": 53.92, "90th_percentile": 53.92, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 122.05 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 149.55 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 119.64 } ] } ] }, { "description": "Ketorolac Tromethamine IM Inj 60 MG/2ML (30 MG/ML)", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "25021070102", "type": "NDC" }, { "code": "J1885", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.575, "maximum": 8.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 12.77, "10th_percentile": 12.77, "90th_percentile": 13.54, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.4 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2.35 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.88 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2.35 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2.35 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.58 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 6.25, "10th_percentile": 6.25, "90th_percentile": 6.25, "count": "1 through 10" } ] } ] }, { "description": "HC SEMEN ANALYSIS,MOTIL & COUNT W/O HUHNER", "code_information": [ { "code": "89310", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 157.5, "discounted_cash": 45.0, "minimum": 8.61, "maximum": 142.8525, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 71.06 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 87.07 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 69.66 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 87.07 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 87.07 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 79.82 }, { "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" } ] } ] }, { "description": "SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC", "code_information": [ { "code": "872", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7621.0, "minimum": 7621.92, "maximum": 12063.66, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "other", "standard_charge_dollar": 7621.92, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 13649.44, "10th_percentile": 13649.44, "90th_percentile": 13649.44, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 7621.92, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 10279.35, "10th_percentile": 10279.35, "90th_percentile": 10279.35, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "other", "standard_charge_dollar": 7621.92, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 8721.12, "10th_percentile": 8721.12, "90th_percentile": 8721.12, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12063.66 } ] } ] }, { "description": "HC ORTHOTICS/PROSTH MGMT &/TRAINJ SBSQ ENCTR 15 MIN", "code_information": [ { "code": "97763", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 178.44, "discounted_cash": 51.0, "minimum": 47.28, "maximum": 161.8451, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 47.28, "additional_payer_notes": "100.00% 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": 6725.0, "minimum": 6725.22, "maximum": 45908.65, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 45908.65 } ] } ] }, { "description": "PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR", "code_information": [ { "code": "041", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8518.0, "minimum": 8518.61, "maximum": 25920.43, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25920.43 } ] } ] }, { "description": "HC HHV-6, DNA AMP PROBE", "code_information": [ { "code": "87532", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 400.0, "discounted_cash": 116.0, "minimum": 35.09, "maximum": 362.8, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 214.99 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 263.43 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 210.75 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 263.43 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 263.43 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 325.3 }, { "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" } ] } ] }, { "description": "HC (SUP SHELL L2840) TIBIAL LENGTH SOCK FX OR EQU", "code_information": [ { "code": "L2840", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 50.37, "maximum": 50.37, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 50.37, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC", "code_information": [ { "code": "726", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5604.0, "minimum": 5604.35, "maximum": 8511.64, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8511.64 } ] } ] }, { "description": "HC (SUP SHELL A6454) SELF-ADHER BAND W>=3 <5/YD - A6454 - 27100097", "code_information": [ { "code": "A6454", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.12, "maximum": 1.12, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.12, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF PARATHORMONE", "code_information": [ { "code": "83970", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 338.13, "discounted_cash": 98.0, "minimum": 41.28, "maximum": 338.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 193.68, "10th_percentile": 193.68, "90th_percentile": 193.68, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 97.38, "10th_percentile": 97.38, "90th_percentile": 97.38, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.13 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 338.13 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 93.81, "10th_percentile": 93.81, "90th_percentile": 93.81, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 333.99 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 338.13 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 338.13 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 172.31, "10th_percentile": 172.31, "90th_percentile": 172.31, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 216.7, "10th_percentile": 212.61, "90th_percentile": 216.7, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 338.13 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 184.96, "10th_percentile": 93.48, "90th_percentile": 270.5, "count": "15" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 270.5, "10th_percentile": 270.5, "90th_percentile": 270.5, "count": "18" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 86.56, "10th_percentile": 86.56, "90th_percentile": 86.56, "count": "31" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 245.34, "10th_percentile": 245.34, "90th_percentile": 245.34, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 86.56, "10th_percentile": 86.56, "90th_percentile": 86.56, "count": "27" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 86.56, "10th_percentile": 86.56, "90th_percentile": 86.56, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 86.56, "10th_percentile": 86.56, "90th_percentile": 91.97, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL A6407) PACKING STRIPS, NON-IMPREG - A6407 - RU272061", "code_information": [ { "code": "A6407", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2.66, "maximum": 2.66, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2.66, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4556) ELECTRODES, PAIR", "code_information": [ { "code": "A4556", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 14.71, "maximum": 14.71, "payers_information": [ { "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" } ] } ] }, { "description": "APPENDIX PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "399", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4035.0, "minimum": 4035.13, "maximum": 13494.85, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13494.85 } ] } ] }, { "description": "HC VENOGRAM RENAL UNILAT", "code_information": [ { "code": "75831", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10857.5, "discounted_cash": 3148.0, "minimum": 580.8918, "maximum": 9847.7525, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 843.2 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1033.21 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 826.56 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1033.21 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1033.21 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 580.89 } ] } ] }, { "description": "Meropenem IV For Soln 1 GM", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "44567014601", "type": "NDC" }, { "code": "J2185", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.3545, "maximum": 11.92, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2.02 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.62 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2.02 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2.02 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.35 } ] } ] }, { "description": "HC (SUP SHELL Q4001) CAST SUP BODY CAST PLASTER", "code_information": [ { "code": "Q4001", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 62.36, "maximum": 62.36, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 62.36, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "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": "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" } ] } ] }, { "description": "HC RICKETTSIA", "code_information": [ { "code": "86757", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 477.19, "discounted_cash": 138.0, "minimum": 19.35, "maximum": 432.8113, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 159.76 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 195.76 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 156.61 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 195.76 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 195.76 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 179.38 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC US,RETROPERIT, B-SCAN/REAL TIME,COMPLETE", "code_information": [ { "code": "76770", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1185.94, "discounted_cash": 343.0, "minimum": 343.9226, "maximum": 1075.6476, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 693.63, "10th_percentile": 693.63, "90th_percentile": 728.64, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 322.2, "10th_percentile": 322.2, "90th_percentile": 341.55, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 459.41 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 310.39, "10th_percentile": 310.39, "90th_percentile": 310.39, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 367.53 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 459.41 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 459.41 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 570.12, "10th_percentile": 570.12, "90th_percentile": 570.12, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 623.16 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 303.6, "10th_percentile": 303.6, "90th_percentile": 304.3, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 948.75, "10th_percentile": 895.0, "90th_percentile": 948.75, "count": "12" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 303.6, "10th_percentile": 286.4, "90th_percentile": 303.6, "count": "17" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 860.52, "10th_percentile": 860.52, "90th_percentile": 860.52, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 303.6, "10th_percentile": 286.4, "90th_percentile": 303.6, "count": "12" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 303.6, "10th_percentile": 303.6, "90th_percentile": 303.6, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 303.6, "10th_percentile": 286.4, "90th_percentile": 304.3, "count": "1 through 10" } ] } ] }, { "description": "HC HIV-1/HIV-2, SINGLE ASSAY", "code_information": [ { "code": "86703", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 114.06, "discounted_cash": 33.0, "minimum": 13.71, "maximum": 114.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 61.58, "10th_percentile": 61.58, "90th_percentile": 70.08, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 87.11 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 106.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 85.4 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 106.75 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 106.75 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 58.13, "10th_percentile": 54.78, "90th_percentile": 58.13, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 68.89, "10th_percentile": 68.89, "90th_percentile": 68.89, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 114.06 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 91.25, "10th_percentile": 86.0, "90th_percentile": 91.25, "count": "131" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 78.78, "10th_percentile": 78.78, "90th_percentile": 82.76, "count": "1 through 10" } ] } ] }, { "description": "HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC", "code_information": [ { "code": "481", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9639.0, "minimum": 9639.48, "maximum": 24692.02, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24692.02 } ] } ] }, { "description": "BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC", "code_information": [ { "code": "409", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9639.0, "minimum": 9639.48, "maximum": 25668.15, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25668.15 } ] } ] }, { "description": "HC (SUP SHELL L4398) FOOT DROP SPLINT PRE OTS", "code_information": [ { "code": "L4398", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 96.81, "maximum": 96.81, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 96.81, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC CHEMOTHER HORMON ANTINEOPL SUB-Q/IM", "code_information": [ { "code": "96402", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 523.44, "discounted_cash": 151.0, "minimum": 151.7976, "maximum": 474.7601, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 285.51, "10th_percentile": 285.51, "90th_percentile": 285.51, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 150.75, "10th_percentile": 150.75, "90th_percentile": 150.75, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 260.26, "10th_percentile": 214.53, "90th_percentile": 268.17, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 138.29, "10th_percentile": 138.29, "90th_percentile": 138.29, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 398.75, "10th_percentile": 398.75, "90th_percentile": 418.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 398.75, "10th_percentile": 398.75, "90th_percentile": 418.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 127.6, "10th_percentile": 127.6, "90th_percentile": 268.0, "count": "13" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 134.0, "10th_percentile": 134.0, "90th_percentile": 268.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 134.0, "10th_percentile": 134.0, "90th_percentile": 268.0, "count": "1 through 10" } ] } ] }, { "description": "HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC", "code_information": [ { "code": "522", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8966.0, "minimum": 8966.96, "maximum": 24965.52, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24965.52 } ] } ] }, { "description": "HC ASSAY OF LACTIC ACID", "code_information": [ { "code": "83605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 173.75, "discounted_cash": 50.0, "minimum": 11.57, "maximum": 157.5913, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 99.52, "10th_percentile": 99.52, "90th_percentile": 99.52, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 50.04, "10th_percentile": 50.04, "90th_percentile": 50.04, "count": "11" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 107.99 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 48.21, "10th_percentile": 48.21, "90th_percentile": 96.41, "count": "22" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 86.39 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 107.99 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 107.99 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 113.98, "10th_percentile": 111.34, "90th_percentile": 227.96, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 111.35, "10th_percentile": 109.25, "90th_percentile": 218.51, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 107.26 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 139.0, "10th_percentile": 20.26, "90th_percentile": 278.0, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 139.0, "10th_percentile": 139.0, "90th_percentile": 139.0, "count": "113" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 44.48, "10th_percentile": 44.48, "90th_percentile": 88.96, "count": "47" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 127.32, "10th_percentile": 44.48, "90th_percentile": 254.65, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 44.48, "10th_percentile": 44.48, "90th_percentile": 88.96, "count": "41" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 44.48, "10th_percentile": 44.48, "90th_percentile": 88.96, "count": "42" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 44.48, "10th_percentile": 44.48, "90th_percentile": 47.26, "count": "12" } ] } ] }, { "description": "HC HEPATITIS B AG, EIA", "code_information": [ { "code": "87350", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 136.56, "discounted_cash": 39.0, "minimum": 11.53, "maximum": 123.8599, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 95.14 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 116.58 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 93.27 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 116.58 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 116.58 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 106.89 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 103.0, "10th_percentile": 103.0, "90th_percentile": 109.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 32.96, "10th_percentile": 32.96, "90th_percentile": 32.96, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 99.09, "10th_percentile": 99.09, "90th_percentile": 99.09, "count": "1 through 10" } ] } ] }, { "description": "SOFT TISSUE PROCEDURES WITH CC", "code_information": [ { "code": "501", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8966.0, "minimum": 8966.96, "maximum": 20608.32, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20608.32 } ] } ] }, { "description": "BONE DISEASES AND ARTHROPATHIES WITH MCC", "code_information": [ { "code": "553", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8966.0, "minimum": 8966.96, "maximum": 15282.05, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15282.05 } ] } ] }, { "description": "HC EDUCATION&TRAINING SELF-MGMT NONPHYS 2-4 PTS", "code_information": [ { "code": "98961", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 94.69, "discounted_cash": 27.0, "minimum": 27.4601, "maximum": 94.69, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 94.69 } ] } ] }, { "description": "WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC", "code_information": [ { "code": "463", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23762.0, "minimum": 23762.44, "maximum": 67191.29, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 67191.29 } ] } ] }, { "description": "HC CLINICAL CHEMISTRY TEST", "code_information": [ { "code": "84999", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 94.06, "discounted_cash": 27.0, "minimum": 27.2774, "maximum": 85.3124, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 2700.0, "10th_percentile": 2700.0, "90th_percentile": 2700.0, "count": "1 through 10" } ] } ] }, { "description": "HC EXAM,SYNOVIAL FLUID CRYSTALS", "code_information": [ { "code": "89060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 125.31, "discounted_cash": 36.0, "minimum": 7.33, "maximum": 113.6562, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 59.02 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 72.32 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 34.77, "10th_percentile": 34.77, "90th_percentile": 34.77, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 57.85 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 72.32 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 72.32 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 67.95 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 94.5, "10th_percentile": 94.5, "90th_percentile": 94.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 90.93, "10th_percentile": 90.93, "90th_percentile": 90.93, "count": "1 through 10" } ] } ] }, { "description": "HC PHENOTYPE DNA HIV W/CULTURE, FIRST 10 DRUGS", "code_information": [ { "code": "87903", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3095.0, "discounted_cash": 897.0, "minimum": 488.66, "maximum": 3095.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3095.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3095.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3095.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 3095.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 3095.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3095.0 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 488.66, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC DNA ANTIBODY, SINGLE STRAND", "code_information": [ { "code": "86226", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 190.94, "discounted_cash": 55.0, "minimum": 12.11, "maximum": 173.1826, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 99.95 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 122.47 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 97.98 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 122.47 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 122.47 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 112.27 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC ANTIEPILEPTICS NOT OTHERWISE SPECIFIED 1-3 - 80339 - 30100444", "code_information": [ { "code": "80339", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 874.38, "discounted_cash": 253.0, "minimum": 46.3525, "maximum": 793.0627, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 46.35 } ] } ] }, { "description": "Aminophylline Inj 25 MG/ML", "drug_information": { "unit": 20.0, "type": "ML" }, "code_information": [ { "code": "00409592201", "type": "NDC" }, { "code": "J0280", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 34.8075, "maximum": 100.37, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 100.37 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 51.91 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 41.53 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 51.91 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 51.91 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.81 } ] } ] }, { "description": "HC PROSTHETIC TRAIN INITIAL ENCTR EA 15 MIN", "code_information": [ { "code": "97761", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 147.5, "discounted_cash": 42.0, "minimum": 38.42, "maximum": 133.7825, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 38.42, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CCMCC", "code_information": [ { "code": "290", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6501.0, "minimum": 6501.05, "maximum": 10960.21, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10960.21 } ] } ] }, { "description": "HC CREATININE CLEARANCE TEST", "code_information": [ { "code": "82575", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 234.38, "discounted_cash": 67.0, "minimum": 9.46, "maximum": 212.5827, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 77.96 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 95.52 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 76.42 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 95.52 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 95.52 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 87.7 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 9.46, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Prednisone Tab 10 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "60687013411", "type": "NDC" }, { "code": "J7512", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC GENERAL HEALTH PANEL", "code_information": [ { "code": "80050", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 720.63, "discounted_cash": 208.0, "minimum": 208.9827, "maximum": 653.6114, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 463.15 } ] } ] }, { "description": "HC US, CHEST,REAL TIME", "code_information": [ { "code": "76604", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 536.56, "discounted_cash": 155.0, "minimum": 155.6024, "maximum": 486.6599, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 248.04, "10th_percentile": 248.04, "90th_percentile": 248.04, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 287.82 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 230.25 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 287.82 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 287.82 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 256.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 650.0, "10th_percentile": 650.0, "90th_percentile": 689.0, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 220.48, "10th_percentile": 220.48, "90th_percentile": 220.48, "count": "1 through 10" } ] } ] }, { "description": "HC ALLERGEN SPEC IGE RECOMBINANT/PURIFIED COMPNT EA", "code_information": [ { "code": "86008", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 49.38, "discounted_cash": 14.0, "minimum": 14.3202, "maximum": 49.38, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 49.38 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 49.38 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 49.38 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 49.38 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 49.38 }, { "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" } ] } ] }, { "description": "HC ASSAY OF URINE OSMOLALITY", "code_information": [ { "code": "83935", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 191.88, "discounted_cash": 55.0, "minimum": 6.82, "maximum": 174.0352, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 56.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 68.92 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 53.23, "10th_percentile": 53.23, "90th_percentile": 53.23, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 55.14 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 68.92 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 68.92 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 63.22 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 153.5, "10th_percentile": 153.5, "90th_percentile": 153.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 49.12, "10th_percentile": 6.82, "90th_percentile": 49.12, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 49.12, "10th_percentile": 49.12, "90th_percentile": 49.12, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 49.12, "10th_percentile": 49.12, "90th_percentile": 49.12, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 49.12, "10th_percentile": 49.12, "90th_percentile": 49.12, "count": "1 through 10" } ] } ] }, { "description": "HC ENTAMOEB HIST GROUP AG EIA", "code_information": [ { "code": "87337", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 198.13, "discounted_cash": 57.0, "minimum": 11.98, "maximum": 179.7039, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 94.58 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 115.89 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 92.71 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 115.89 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 115.89 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 111.06 }, { "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 Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 11.98, "10th_percentile": 11.98, "90th_percentile": 11.98, "count": "1 through 10" } ] } ] }, { "description": "HC CYCLIC CIRULLINATED PEPTIDE ANTIBODY", "code_information": [ { "code": "86200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 225.0, "discounted_cash": 65.0, "minimum": 12.95, "maximum": 204.075, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 131.56, "10th_percentile": 131.56, "90th_percentile": 131.56, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 64.8, "10th_percentile": 64.8, "90th_percentile": 64.8, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 106.9 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 130.99 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 104.79 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 130.99 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 130.99 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 120.05 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 70.53, "10th_percentile": 70.53, "90th_percentile": 70.53, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 169.75, "10th_percentile": 169.75, "90th_percentile": 180.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 57.6, "10th_percentile": 54.32, "90th_percentile": 57.6, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 57.6, "10th_percentile": 57.6, "90th_percentile": 62.81, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 57.6, "10th_percentile": 57.6, "90th_percentile": 57.6, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL V2630) ANTERIOR CHAMBER INTRAOCULAR LENS", "code_information": [ { "code": "V2630", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 145.73, "maximum": 145.73, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 145.73, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BRONCHITIS AND ASTHMA WITHOUT CCMCC", "code_information": [ { "code": "203", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4931.0, "minimum": 4931.83, "maximum": 7898.62, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7898.62 } ] } ] }, { "description": "TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC", "code_information": [ { "code": "012", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19278.0, "minimum": 19278.96, "maximum": 49702.34, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 49702.34 } ] } ] }, { "description": "HC ANTIDEPRESSANTS SEROTONERGIC CLASS 1 OR 2 - 80332 - 31080332", "code_information": [ { "code": "80332", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 114.06, "discounted_cash": 33.0, "minimum": 33.0774, "maximum": 114.06, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 114.06 } ] } ] }, { "description": "MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "346", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5828.0, "minimum": 5828.52, "maximum": 13984.09, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13984.09 } ] } ] }, { "description": "HC SURG PATH,LEVEL III", "code_information": [ { "code": "88304", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 371.25, "discounted_cash": 107.0, "minimum": 107.6625, "maximum": 367.4826, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 367.48 } ] } ] }, { "description": "HC TC-99M, PER STUDY DOSE", "code_information": [ { "code": "A9500", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 407.19, "minimum": 118.0851, "maximum": 369.3213, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 343.0 } ] } ] }, { "description": "HC HELMINTH, ANTIBODY", "code_information": [ { "code": "86682", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 152.5, "discounted_cash": 44.0, "minimum": 13.01, "maximum": 138.3175, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 80.56 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 98.71 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 78.97 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 98.71 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 98.71 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 120.61 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.01, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC", "code_information": [ { "code": "563", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6725.0, "minimum": 6725.22, "maximum": 12852.054, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10557.03 } ] } ] }, { "description": "HC (SUP SHELL L0460) TLSO 2 SHL SYMPHYS-STERN CST", "code_information": [ { "code": "L0460", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1204.08, "maximum": 1204.08, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1204.08, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC OTHER SOURCE ALBUMIN QUAN EA", "code_information": [ { "code": "82042", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 43.13, "discounted_cash": 12.0, "minimum": 7.78, "maximum": 43.13, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 42.74 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 43.13 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 41.89 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 43.13 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 43.13 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 43.13 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% 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": "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" } ] } ] }, { "description": "HC ASSAY OF PHENOBARBITAL", "code_information": [ { "code": "80184", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 246.25, "discounted_cash": 71.0, "minimum": 15.3, "maximum": 223.3487, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 94.52 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 115.82 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 64.42, "10th_percentile": 64.42, "90th_percentile": 68.32, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 92.66 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 115.82 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 115.82 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 141.84 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 117.91, "10th_percentile": 117.91, "90th_percentile": 117.91, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 63.04, "10th_percentile": 63.04, "90th_percentile": 63.04, "count": "1 through 10" } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC", "code_information": [ { "code": "220", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12105.0, "minimum": 12105.4, "maximum": 62868.27, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 62868.27 } ] } ] }, { "description": "HC BLOOD TRANSFUSION SERVICE", "code_information": [ { "code": "36430", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1605.63, "discounted_cash": 465.0, "minimum": 465.6327, "maximum": 1456.3064, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 462.42, "10th_percentile": 396.0, "90th_percentile": 462.42, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 822.59, "10th_percentile": 822.59, "90th_percentile": 822.59, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 445.46, "10th_percentile": 424.23, "90th_percentile": 445.46, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.1, "median_amount": 1003.07, "10th_percentile": 1003.07, "90th_percentile": 1003.07, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1284.5, "10th_percentile": 1223.25, "90th_percentile": 1284.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 391.44, "10th_percentile": 391.44, "90th_percentile": 415.91, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 411.04, "10th_percentile": 411.04, "90th_percentile": 411.04, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 411.04, "10th_percentile": 411.04, "90th_percentile": 411.04, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 411.04, "10th_percentile": 391.44, "90th_percentile": 415.91, "count": "1 through 10" } ] } ] }, { "description": "Methylprednisolone Tab 4 MG", "drug_information": { "unit": 100.0, "type": "EA" }, "code_information": [ { "code": "00603459321", "type": "NDC" }, { "code": "J7509", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 3.99, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.13 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.13 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.13 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC INJ, THERAP/PROPH/DIAGN, IM OR SUBCUT", "code_information": [ { "code": "96372", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 169.06, "discounted_cash": 49.0, "minimum": 49.0274, "maximum": 153.3374, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 129.04, "10th_percentile": 119.21, "90th_percentile": 387.36, "count": "1 through 10" } ] } ] }, { "description": "MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH MCC", "code_information": [ { "code": "722", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11208.0, "minimum": 11208.7, "maximum": 21334.52, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21334.52 } ] } ] }, { "description": "HC RHEUMATOID FACTOR, QUANT", "code_information": [ { "code": "86431", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 165.94, "discounted_cash": 48.0, "minimum": 5.67, "maximum": 150.5076, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 89.68, "10th_percentile": 89.68, "90th_percentile": 97.07, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 46.86 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 57.42 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 45.94 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 57.42 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 57.42 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 52.56 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.67, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC IMMUNOGLOBULIN ASSAY, PLATELET", "code_information": [ { "code": "86023", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 848.44, "discounted_cash": 246.0, "minimum": 12.46, "maximum": 769.5351, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 102.83 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 126.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 100.8 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 126.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 126.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 115.51 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.46, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC ELEC STIM OTHER THAN WOUND - 97014 - 42000014", "code_information": [ { "code": "97014", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 80.63, "discounted_cash": 23.0, "minimum": 23.3827, "maximum": 80.63, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 80.63 } ] } ] }, { "description": "HC (SUP SHELL A6021) COLLAGEN DRESSING <=16 SQ IN - A6021 - RU272038", "code_information": [ { "code": "A6021", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 29.97, "maximum": 29.97, "payers_information": [ { "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" } ] } ] }, { "description": "OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITH CCMCC", "code_information": [ { "code": "715", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11208.0, "minimum": 11208.7, "maximum": 26375.48, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26375.48 } ] } ] }, { "description": "ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH CC", "code_information": [ { "code": "062", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6725.0, "minimum": 6725.22, "maximum": 20715.6, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20715.6 } ] } ] }, { "description": "OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "831", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7397.0, "minimum": 7397.74, "maximum": 14176.25, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14176.25 } ] } ] }, { "description": "Enoxaparin Sodium Inj Soln Pref Syr 40 MG/0.4ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "71288043382", "type": "NDC" }, { "code": "J1650", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.638, "maximum": 12.8, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.8 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2.44 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.95 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2.44 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2.44 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.64 } ] } ] }, { "description": "HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "514", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4707.0, "minimum": 4707.65, "maximum": 12051.87, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12051.87 } ] } ] }, { "description": "OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "628", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18606.0, "minimum": 18606.44, "maximum": 43935.17, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 43935.17 } ] } ] }, { "description": "HC METABOLIC PANEL,COMPREHENSIVE", "code_information": [ { "code": "80053", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 336.88, "discounted_cash": 97.0, "minimum": 10.56, "maximum": 305.5502, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 182.04, "10th_percentile": 182.04, "90th_percentile": 197.04, "count": "63" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 97.02, "10th_percentile": 91.53, "90th_percentile": 97.02, "count": "272" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 87.28 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 106.95 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 93.46, "10th_percentile": 88.18, "90th_percentile": 93.46, "count": "361" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 85.56 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 106.95 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 106.95 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 171.67, "10th_percentile": 171.67, "90th_percentile": 171.67, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 211.83, "10th_percentile": 203.68, "90th_percentile": 211.83, "count": "126" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 97.9 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 108.08, "10th_percentile": 18.33, "90th_percentile": 269.5, "count": "118" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 62.64, "10th_percentile": 58.23, "90th_percentile": 62.64, "count": "12" }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 269.5, "10th_percentile": 254.25, "90th_percentile": 269.5, "count": "1637" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 86.24, "10th_percentile": 81.36, "90th_percentile": 86.24, "count": "899" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 232.89, "10th_percentile": 232.89, "90th_percentile": 232.89, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 86.24, "10th_percentile": 81.36, "90th_percentile": 94.07, "count": "726" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 86.24, "10th_percentile": 81.36, "90th_percentile": 86.45, "count": "290" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 86.24, "10th_percentile": 81.36, "90th_percentile": 86.45, "count": "383" } ] } ] }, { "description": "HC MAMMOGRAM, SCREENING", "code_information": [ { "code": "77067", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 667.5, "discounted_cash": 193.0, "minimum": 83.79, "maximum": 667.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 382.34, "10th_percentile": 382.34, "90th_percentile": 382.34, "count": "15" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 192.24, "10th_percentile": 192.24, "90th_percentile": 192.24, "count": "64" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.47 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 498.07 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 185.19, "10th_percentile": 185.19, "90th_percentile": 185.19, "count": "51" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 398.45 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 498.07 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 498.07 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 340.16, "10th_percentile": 340.16, "90th_percentile": 340.16, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 419.72, "10th_percentile": 419.72, "90th_percentile": 427.79, "count": "33" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 667.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 170.88, "10th_percentile": 170.88, "90th_percentile": 181.56, "count": "64" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 115.7, "10th_percentile": 115.7, "90th_percentile": 115.7, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 83.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 83.56, "10th_percentile": 83.56, "90th_percentile": 85.16, "count": "118" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 81.72, "10th_percentile": 81.72, "90th_percentile": 83.79, "count": "136" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 489.14, "10th_percentile": 426.83, "90th_percentile": 489.14, "count": "19" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 115.41, "10th_percentile": 115.41, "90th_percentile": 117.63, "count": "83" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 170.88, "10th_percentile": 170.88, "90th_percentile": 181.56, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 170.88, "10th_percentile": 170.88, "90th_percentile": 181.56, "count": "53" } ] } ] }, { "description": "AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC", "code_information": [ { "code": "268", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13674.0, "minimum": 13674.61, "maximum": 81083.43, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 81083.43 } ] } ] }, { "description": "HC (SUP SHELL A6231) HYDROGEL DSG<=16 SQ IN", "code_information": [ { "code": "A6231", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 6.66, "maximum": 6.66, "payers_information": [ { "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" } ] } ] }, { "description": "HC ASSAY OF SEX HORMONE BINDING GLOBULIN", "code_information": [ { "code": "84270", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 138.13, "discounted_cash": 40.0, "minimum": 21.73, "maximum": 138.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 169.73, "10th_percentile": 169.73, "90th_percentile": 169.73, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 138.13 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 138.13 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 138.13 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 138.13 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 138.13 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 88.52, "10th_percentile": 88.52, "90th_percentile": 88.52, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 138.13 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 110.5, "10th_percentile": 110.5, "90th_percentile": 110.5, "count": "25" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 35.36, "10th_percentile": 35.36, "90th_percentile": 37.57, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 100.22, "10th_percentile": 100.22, "90th_percentile": 101.22, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 35.36, "10th_percentile": 35.36, "90th_percentile": 40.89, "count": "13" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 35.36, "10th_percentile": 35.36, "90th_percentile": 35.36, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 35.36, "10th_percentile": 35.36, "90th_percentile": 35.36, "count": "1 through 10" } ] } ] }, { "description": "LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITHOUT CCMCC", "code_information": [ { "code": "499", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4035.0, "minimum": 4035.13, "maximum": 23752.44, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23752.44 } ] } ] }, { "description": "HC HTLV/HIV CONFIRMATORY TEST", "code_information": [ { "code": "86689", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 324.69, "discounted_cash": 94.0, "minimum": 19.35, "maximum": 294.4938, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 159.76 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 195.76 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 156.61 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 195.76 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 195.76 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 179.38 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 259.75, "10th_percentile": 245.0, "90th_percentile": 259.75, "count": "1 through 10" } ] } ] }, { "description": "CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CCMCC", "code_information": [ { "code": "839", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8966.0, "minimum": 8966.96, "maximum": 17022.11, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17022.11 } ] } ] }, { "description": "HC (SUP SHELL A6222) GAUZE <=16 IN NO W/SAL W/O B - A6222 - 27200126", "code_information": [ { "code": "A6222", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 3.04, "maximum": 3.04, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3.04, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY SHOULDER 2+ VW", "code_information": [ { "code": "73030", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 537.5, "discounted_cash": 155.0, "minimum": 80.1, "maximum": 487.5125, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 290.52, "10th_percentile": 290.52, "90th_percentile": 290.52, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 154.8, "10th_percentile": 146.07, "90th_percentile": 154.8, "count": "13" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 81.71 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 100.12 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 149.12, "10th_percentile": 140.72, "90th_percentile": 149.12, "count": "12" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 80.1 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 100.12 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 100.12 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 273.91, "10th_percentile": 258.46, "90th_percentile": 344.43, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 325.05, "10th_percentile": 325.05, "90th_percentile": 325.05, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 219.97 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 137.96, "10th_percentile": 137.6, "90th_percentile": 275.2, "count": "15" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 430.0, "10th_percentile": 405.75, "90th_percentile": 430.0, "count": "69" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 137.6, "10th_percentile": 129.84, "90th_percentile": 137.96, "count": "26" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 390.01, "10th_percentile": 371.67, "90th_percentile": 390.01, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 137.6, "10th_percentile": 129.84, "90th_percentile": 137.6, "count": "31" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 137.6, "10th_percentile": 129.84, "90th_percentile": 137.96, "count": "14" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 137.6, "10th_percentile": 129.84, "90th_percentile": 137.96, "count": "12" } ] } ] }, { "description": "HC X-RAY FOR PANCREAS ENDOSCOPY", "code_information": [ { "code": "74329", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2509.38, "discounted_cash": 727.0, "minimum": 265.98, "maximum": 2276.0077, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 271.33 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 332.48 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 265.98 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 332.48 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 332.48 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 360.92 } ] } ] }, { "description": "VENTRICULAR SHUNT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "033", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3362.0, "minimum": 3362.61, "maximum": 19603.89, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19603.89 } ] } ] }, { "description": "HC NM BONE IMAGING, MULTIPLE AREAS", "code_information": [ { "code": "78305", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 874.38, "discounted_cash": 253.0, "minimum": 253.5702, "maximum": 874.38, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 723.59 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 874.38 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 709.32 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 874.38 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 874.38 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 874.38 } ] } ] }, { "description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "515", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15019.0, "minimum": 15019.66, "maximum": 37570.3, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 37570.3 } ] } ] }, { "description": "URINARY STONES WITHOUT MCC", "code_information": [ { "code": "694", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4707.0, "minimum": 4707.65, "maximum": 9215.45, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9215.45 } ] } ] }, { "description": "HC (SUP SHELL L8606) SYNTHETIC IMPLNT URINARY 1ML", "code_information": [ { "code": "L8606", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 263.47, "maximum": 263.47, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 263.47, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC EPSTEIN-BARR ANTIBODY,EARLY", "code_information": [ { "code": "86663", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 206.56, "discounted_cash": 59.0, "minimum": 13.12, "maximum": 187.3499, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 108.31 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 132.72 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 106.18 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 132.72 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 132.72 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 121.63 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.12, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC OCCUP THRP RE-EVAL, 30 MIN", "code_information": [ { "code": "97168", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 354.06, "discounted_cash": 102.0, "minimum": 65.46, "maximum": 321.1324, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 65.46, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HEART FAILURE AND SHOCK WITH MCC", "code_information": [ { "code": "291", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8518.0, "minimum": 8518.61, "maximum": 15858.6189, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "other", "standard_charge_dollar": 8518.61, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 3044.77, "10th_percentile": 3044.77, "90th_percentile": 3044.77, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "other", "standard_charge_dollar": 8901.96, "standard_charge_algorithm": "2342.62 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 16545.77, "10th_percentile": 16545.77, "90th_percentile": 20678.45, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 8518.61, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 6431.46, "10th_percentile": 6431.46, "90th_percentile": 10719.1, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "other", "standard_charge_dollar": 8518.61, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 6720.0, "10th_percentile": 6720.0, "90th_percentile": 6720.0, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "other", "standard_charge_dollar": 8518.61, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 4802.14, "10th_percentile": 4802.14, "90th_percentile": 4802.14, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15134.69 } ] } ] }, { "description": "MAJOR BLADDER PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "655", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7173.0, "minimum": 7173.57, "maximum": 24952.56, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24952.56 } ] } ] }, { "description": "OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC", "code_information": [ { "code": "957", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22641.0, "minimum": 22641.57, "maximum": 89830.85, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 89830.85 } ] } ] }, { "description": "RESPIRATORY NEOPLASMS WITHOUT CCMCC", "code_information": [ { "code": "182", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4931.0, "minimum": 4931.83, "maximum": 8886.53, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8886.53 } ] } ] }, { "description": "OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "168", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4035.0, "minimum": 4035.13, "maximum": 16108.46, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16108.46 } ] } ] }, { "description": "HC IADNA SARSCOV2 & INF A&B & RSV MULT AMP PROBE TQ", "code_information": [ { "code": "87637", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 750.63, "discounted_cash": 217.0, "minimum": 142.63, "maximum": 750.63, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 750.63 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 142.63, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH MCC", "code_information": [ { "code": "456", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21072.0, "minimum": 21072.36, "maximum": 99067.51, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 99067.51 } ] } ] }, { "description": "NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CCMCC", "code_information": [ { "code": "989", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5156.0, "minimum": 5156.0, "maximum": 14137.34, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14137.34 } ] } ] }, { "description": "Pyridoxine HCl Inj 100 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "63323018001", "type": "NDC" }, { "code": "J3415", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 39.5955, "maximum": 139.93, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 139.93 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 59.05 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 47.24 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 59.05 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 59.05 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.6 } ] } ] }, { "description": "HC VENOGRAM ADRENAL UNILAT", "code_information": [ { "code": "75840", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1634.06, "discounted_cash": 473.0, "minimum": 473.8774, "maximum": 1482.0924, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 837.38 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1026.07 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 820.86 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1026.07 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1026.07 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 634.43 } ] } ] }, { "description": "HC CLOTTING FUNCT ACTIVITY", "code_information": [ { "code": "85397", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 757.81, "discounted_cash": 219.0, "minimum": 30.86, "maximum": 687.3337, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 189.44 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 232.12 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 185.7 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 232.12 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 232.12 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 286.09 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC", "code_information": [ { "code": "216", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23762.0, "minimum": 23762.44, "maximum": 115329.23, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 115329.23 } ] } ] }, { "description": "HC SURG PATH,LEVEL VI", "code_information": [ { "code": "88309", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 848.75, "discounted_cash": 246.0, "minimum": 246.1375, "maximum": 848.75, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 848.75 } ] } ] }, { "description": "HC (SUP SHELL Q4107) GRAFTJACKET", "code_information": [ { "code": "Q4107", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 291.6585, "maximum": 1341.64, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1341.64 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 403.82 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 323.05 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 403.82 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 403.82 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 291.66 } ] } ] }, { "description": "HC (SUP SHELL A6248) HYDROGEL DRSG GEL FILLER - A6248 - 27100089", "code_information": [ { "code": "A6248", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 23.15, "maximum": 56.04, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 56.04 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 44.84 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 56.04 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 56.04 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 23.15, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6445) CONFORM BAND S W <3/YD", "code_information": [ { "code": "A6445", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "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" } ] } ] }, { "description": "HC NON-SPEECH DEVICE SERVICE", "code_information": [ { "code": "92606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 638.13, "discounted_cash": 185.0, "minimum": 95.0, "maximum": 578.7839, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "HC SPECIMEN CONCENTRAT, INFECT AGENTS", "code_information": [ { "code": "87015", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 104.38, "discounted_cash": 30.0, "minimum": 6.68, "maximum": 94.6727, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 55.12 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 67.54 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 54.03 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 67.54 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 67.54 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 61.93 }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 83.5, "10th_percentile": 83.5, "90th_percentile": 83.5, "count": "1 through 10" } ] } ] }, { "description": "HC IV INFU, THERAP/PROPH/DIAGN, INIT, 1ST HR", "code_information": [ { "code": "96365", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1019.06, "discounted_cash": 295.0, "minimum": 295.5274, "maximum": 924.2874, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 460.93, "10th_percentile": 460.93, "90th_percentile": 583.72, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 231.75, "10th_percentile": 231.75, "90th_percentile": 231.75, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 412.26, "10th_percentile": 412.26, "90th_percentile": 420.18, "count": "44" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 223.26, "10th_percentile": 223.26, "90th_percentile": 223.26, "count": "26" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 79.93, "median_amount": 514.55, "10th_percentile": 514.55, "90th_percentile": 514.55, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 206.0, "10th_percentile": 33.03, "90th_percentile": 643.75, "count": "63" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 95.82, "10th_percentile": 95.82, "90th_percentile": 95.82, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 643.75, "10th_percentile": 643.75, "90th_percentile": 643.75, "count": "70" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 206.0, "10th_percentile": 206.0, "90th_percentile": 218.88, "count": "127" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 583.88, "10th_percentile": 583.88, "90th_percentile": 583.88, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 206.0, "10th_percentile": 206.0, "90th_percentile": 238.19, "count": "55" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 206.0, "10th_percentile": 206.0, "90th_percentile": 218.88, "count": "45" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 206.0, "10th_percentile": 206.0, "90th_percentile": 206.0, "count": "41" } ] } ] }, { "description": "HC ASSAY OF CREATININE", "code_information": [ { "code": "82565", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 62.5, "discounted_cash": 18.0, "minimum": 5.12, "maximum": 56.6875, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 38.4, "10th_percentile": 38.4, "90th_percentile": 38.75, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 18.0, "10th_percentile": 18.0, "90th_percentile": 18.0, "count": "21" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 42.29 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 51.81 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 17.34, "10th_percentile": 17.34, "90th_percentile": 17.34, "count": "23" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 41.45 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 51.81 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 51.81 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 31.85, "10th_percentile": 31.85, "90th_percentile": 31.85, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 47.47 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 50.0, "10th_percentile": 16.65, "90th_percentile": 50.0, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 50.0, "10th_percentile": 50.0, "90th_percentile": 50.0, "count": "22" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 16.0, "10th_percentile": 16.0, "90th_percentile": 17.0, "count": "25" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 45.35, "10th_percentile": 45.35, "90th_percentile": 45.35, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 16.0, "10th_percentile": 16.0, "90th_percentile": 18.5, "count": "35" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 16.0, "10th_percentile": 16.0, "90th_percentile": 17.0, "count": "22" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 16.0, "10th_percentile": 16.0, "90th_percentile": 17.0, "count": "13" } ] } ] }, { "description": "HC CT ANGIO AORTOBIFEMORAL, COMBO", "code_information": [ { "code": "75635", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2311.56, "discounted_cash": 670.0, "minimum": 650.0, "maximum": 2311.56, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1744.7 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1395.75 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1744.7 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1744.7 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2311.56 } ] } ] }, { "description": "HC ASSAY OF CAROTENE", "code_information": [ { "code": "82380", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 128.13, "discounted_cash": 37.0, "minimum": 9.22, "maximum": 116.2139, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 76.15 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 93.31 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 74.65 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 93.31 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 93.31 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 85.47 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ABORTION WITHOUT D&C", "code_information": [ { "code": "779", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3362.0, "minimum": 3362.61, "maximum": 9918.07, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9918.07 } ] } ] }, { "description": "HC ASSAY OF METHADONE - 80358 - 30100205", "code_information": [ { "code": "80358", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 194.38, "discounted_cash": 56.0, "minimum": 56.3702, "maximum": 176.3027, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 121.63 } ] } ] }, { "description": "HC US,PREG UTER,FET & MAT,+ DETL FET EXM", "code_information": [ { "code": "76811", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1164.38, "discounted_cash": 337.0, "minimum": 337.6702, "maximum": 1056.0927, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 563.1 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 450.48 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 563.1 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 563.1 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 747.25 } ] } ] }, { "description": "Epoetin Alfa-epbx Inj 10000 Unit/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00069130801", "type": "NDC" }, { "code": "Q5106", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 22.2705, "maximum": 171.83, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 171.83 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 33.21 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 26.57 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 33.21 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 33.21 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.27 } ] } ] }, { "description": "HC HERPES SIMPLEX TEST, UNSPECIFIED TYPE", "code_information": [ { "code": "86694", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 211.25, "discounted_cash": 61.0, "minimum": 14.39, "maximum": 191.6037, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 118.83 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 145.61 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 116.48 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 145.61 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 145.61 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 133.4 }, { "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" } ] } ] }, { "description": "HC OCCUP THRP EVAL, LOW COMPLEXITY, 30 MIN", "code_information": [ { "code": "97165", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 626.88, "discounted_cash": 181.0, "minimum": 95.0, "maximum": 568.5802, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 180.54, "10th_percentile": 180.54, "90th_percentile": 180.54, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 96.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 160.48, "10th_percentile": 160.48, "90th_percentile": 170.51, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 160.48, "10th_percentile": 160.48, "90th_percentile": 160.48, "count": "1 through 10" } ] } ] }, { "description": "HC CT SCAN OF LEG CONTRAST", "code_information": [ { "code": "73701", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2168.75, "discounted_cash": 628.0, "minimum": 628.9375, "maximum": 1967.0563, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1321.03 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 527.83, "10th_percentile": 527.83, "90th_percentile": 601.7, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1056.82 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1321.03 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1321.03 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 986.96 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 3147.29, "10th_percentile": 3147.29, "90th_percentile": 3147.29, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 473.64, "10th_percentile": 473.64, "90th_percentile": 555.2, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 555.2, "10th_percentile": 555.2, "90th_percentile": 555.2, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL A5061) POUCH DRAINABLE W BARRIER AT", "code_information": [ { "code": "A5061", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 5.04, "maximum": 5.04, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC DIGITAL BREAST TOMOSYNTHESIS UNILAT - 77061 - 40100010", "code_information": [ { "code": "77061", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 501.88, "discounted_cash": 145.0, "minimum": 145.5452, "maximum": 501.88, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 488.7 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 501.88 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 479.06 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 501.88 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 501.88 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 501.88 } ] } ] }, { "description": "HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC", "code_information": [ { "code": "354", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6949.0, "minimum": 6949.39, "maximum": 19833.78, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19833.78 } ] } ] }, { "description": "HC DEXA,BONE DENSITY, 1 + SITE, APPENDICULR SKELTN", "code_information": [ { "code": "77081", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 384.06, "discounted_cash": 111.0, "minimum": 77.24, "maximum": 348.3424, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 104.31, "10th_percentile": 104.31, "90th_percentile": 110.61, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 78.79 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 96.55 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 77.24 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 96.55 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 96.55 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 188.9 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 307.25, "10th_percentile": 289.75, "90th_percentile": 307.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 98.32, "10th_percentile": 92.72, "90th_percentile": 98.32, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 98.32, "10th_percentile": 92.72, "90th_percentile": 98.32, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 98.32, "10th_percentile": 98.32, "90th_percentile": 98.52, "count": "1 through 10" } ] } ] }, { "description": "HC X-RAY RIBS 3 VW BILAT", "code_information": [ { "code": "71110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 688.75, "discounted_cash": 199.0, "minimum": 107.26, "maximum": 624.6962, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 109.41 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 134.07 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 107.26 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 134.07 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 134.07 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 256.57 } ] } ] }, { "description": "AFTERCARE WITHOUT CCMCC", "code_information": [ { "code": "950", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7173.0, "minimum": 7173.57, "maximum": 18474.939, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7399.94 } ] } ] }, { "description": "HC DEXA,BONE DENSITY, 1 + SITE, AXIAL SKELETON", "code_information": [ { "code": "77080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 827.81, "discounted_cash": 240.0, "minimum": 240.0649, "maximum": 750.8237, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 447.32, "10th_percentile": 447.32, "90th_percentile": 447.32, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 238.41, "10th_percentile": 224.91, "90th_percentile": 238.41, "count": "20" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 249.45 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 305.66 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 229.67, "10th_percentile": 216.67, "90th_percentile": 229.67, "count": "27" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 244.53 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 305.66 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 305.66 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 421.85, "10th_percentile": 421.85, "90th_percentile": 421.85, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 520.53, "10th_percentile": 520.53, "90th_percentile": 520.53, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 250.97 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 211.92, "10th_percentile": 84.67, "90th_percentile": 382.8, "count": "31" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 662.25, "10th_percentile": 624.75, "90th_percentile": 662.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 211.92, "10th_percentile": 199.92, "90th_percentile": 211.92, "count": "50" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 529.34, "10th_percentile": 529.34, "90th_percentile": 572.27, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 211.92, "10th_percentile": 199.92, "90th_percentile": 231.16, "count": "50" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 211.92, "10th_percentile": 211.92, "90th_percentile": 212.42, "count": "32" } ] } ] }, { "description": "UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC", "code_information": [ { "code": "255", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15243.0, "minimum": 15243.83, "maximum": 31799.59, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 31799.59 } ] } ] }, { "description": "HC IAAD IA HEPATITIS B SURFACE AG NEUTRALIZATION", "code_information": [ { "code": "87341", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 175.31, "discounted_cash": 50.0, "minimum": 10.33, "maximum": 159.0062, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 85.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 104.46 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 83.57 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 104.46 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 104.46 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.76 }, { "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" } ] } ] }, { "description": "Insulin Aspart Inj 100 Unit/ML", "drug_information": { "unit": 3.0, "type": "ML" }, "code_information": [ { "code": "00169633910", "type": "NDC" }, { "code": "J1815", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 13.8, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.8 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.08 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.08 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.08 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC CYTO/MOLECULAR REPORT", "code_information": [ { "code": "88291", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 380.63, "discounted_cash": 110.0, "minimum": 110.3827, "maximum": 380.63, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 380.63 } ] } ] }, { "description": "ACUTE MAJOR EYE INFECTIONS WITHOUT CCMCC", "code_information": [ { "code": "122", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7173.0, "minimum": 7173.57, "maximum": 9263.78, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9263.78 } ] } ] }, { "description": "HC LACTATE (LD) (LDH) ENZYME", "code_information": [ { "code": "83615", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 127.5, "discounted_cash": 36.0, "minimum": 6.04, "maximum": 115.6425, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 36.72, "10th_percentile": 36.72, "90th_percentile": 36.72, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 61.03 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 35.37, "10th_percentile": 35.37, "90th_percentile": 35.37, "count": "12" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 48.82 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 61.03 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 61.03 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 64.97, "10th_percentile": 64.97, "90th_percentile": 81.7, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 55.99 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 102.0, "10th_percentile": 102.0, "90th_percentile": 102.0, "count": "12" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 102.0, "10th_percentile": 102.0, "90th_percentile": 102.0, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 32.64, "10th_percentile": 32.64, "90th_percentile": 32.64, "count": "27" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 81.18, "10th_percentile": 81.18, "90th_percentile": 81.18, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 32.64, "10th_percentile": 32.64, "90th_percentile": 92.51, "count": "20" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 32.64, "10th_percentile": 32.64, "90th_percentile": 34.68, "count": "16" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 32.64, "10th_percentile": 32.64, "90th_percentile": 32.64, "count": "1 through 10" } ] } ] }, { "description": "HC X-RAY KNEE 3 VIEW", "code_information": [ { "code": "73562", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 564.38, "discounted_cash": 163.0, "minimum": 95.8, "maximum": 511.8927, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 346.75, "10th_percentile": 330.15, "90th_percentile": 349.91, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 162.54, "10th_percentile": 153.36, "90th_percentile": 162.54, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 97.72 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 119.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 147.74, "10th_percentile": 147.74, "90th_percentile": 156.58, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 95.8 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 119.75 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 119.75 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 287.61, "10th_percentile": 271.36, "90th_percentile": 349.32, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 341.27, "10th_percentile": 341.27, "90th_percentile": 341.27, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 270.71 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 144.48, "10th_percentile": 144.48, "90th_percentile": 158.52, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 451.5, "10th_percentile": 426.0, "90th_percentile": 451.5, "count": "54" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 144.48, "10th_percentile": 136.32, "90th_percentile": 144.48, "count": "23" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 409.51, "10th_percentile": 360.88, "90th_percentile": 780.44, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 144.48, "10th_percentile": 136.32, "90th_percentile": 157.62, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 144.48, "10th_percentile": 136.32, "90th_percentile": 144.48, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 144.48, "10th_percentile": 136.32, "90th_percentile": 144.84, "count": "12" } ] } ] }, { "description": "HC DRUG SCREEN QUANT ZONISAMIDE", "code_information": [ { "code": "80203", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 214.38, "discounted_cash": 62.0, "minimum": 13.25, "maximum": 194.4427, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 102.26 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 125.31 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 100.25 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 125.31 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 125.31 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 122.83 }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 12.66, "10th_percentile": 12.66, "90th_percentile": 12.66, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 51.76, "10th_percentile": 51.76, "90th_percentile": 51.76, "count": "1 through 10" } ] } ] }, { "description": "PNEUMOTHORAX WITH MCC", "code_information": [ { "code": "199", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10760.0, "minimum": 10760.35, "maximum": 20796.94, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20796.94 } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC", "code_information": [ { "code": "284", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3362.0, "minimum": 3362.61, "maximum": 8160.33, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8160.33 } ] } ] }, { "description": "HC DIGITAL BREAST TOMOSYNTHESIS BILAT - 77062 - 40100011", "code_information": [ { "code": "77062", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 796.88, "discounted_cash": 231.0, "minimum": 231.0952, "maximum": 796.88, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 383.7 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 470.16 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 376.13 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 470.16 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 470.16 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 796.88 } ] } ] }, { "description": "HC VITAMIN B-12", "code_information": [ { "code": "82607", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 271.88, "discounted_cash": 78.0, "minimum": 15.08, "maximum": 246.5952, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 155.73, "10th_percentile": 155.73, "90th_percentile": 155.73, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 78.3, "10th_percentile": 78.3, "90th_percentile": 78.3, "count": "15" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 123.52 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 151.35 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 75.43, "10th_percentile": 75.43, "90th_percentile": 75.43, "count": "17" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 121.08 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 151.35 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 151.35 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 138.55, "10th_percentile": 138.55, "90th_percentile": 174.22, "count": "13" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 170.96, "10th_percentile": 170.96, "90th_percentile": 174.24, "count": "12" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 139.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 76.15, "10th_percentile": 2.73, "90th_percentile": 217.5, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 50.56, "10th_percentile": 50.56, "90th_percentile": 50.56, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 217.5, "10th_percentile": 217.5, "90th_percentile": 217.5, "count": "125" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 69.6, "10th_percentile": 69.6, "90th_percentile": 69.6, "count": "62" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 197.27, "10th_percentile": 173.85, "90th_percentile": 197.27, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 69.6, "10th_percentile": 69.6, "90th_percentile": 69.6, "count": "49" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 69.6, "10th_percentile": 69.6, "90th_percentile": 73.95, "count": "24" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 69.6, "10th_percentile": 69.6, "90th_percentile": 73.95, "count": "24" } ] } ] }, { "description": "HC BLOOD TYPING, PATIENT SERUM", "code_information": [ { "code": "86904", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 378.13, "discounted_cash": 109.0, "minimum": 76.92, "maximum": 342.9639, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 78.47 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 96.15 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 76.92 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 96.15 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 96.15 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 151.48 } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC", "code_information": [ { "code": "219", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18382.0, "minimum": 18382.27, "maximum": 90519.33, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 90519.33 } ] } ] }, { "description": "HC (SUP SHELL A6255) ABSORPT DRG >16<=48 IN W/BDR - A6255 - RU272057", "code_information": [ { "code": "A6255", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 4.34, "maximum": 4.34, "payers_information": [ { "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" } ] } ] }, { "description": "BENIGN PROSTATIC HYPERTROPHY WITH MCC", "code_information": [ { "code": "725", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8518.0, "minimum": 8518.61, "maximum": 13795.46, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13795.46 } ] } ] }, { "description": "HC PROSTATE SPECIFIC ANTIGEN,FREE", "code_information": [ { "code": "84154", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 402.5, "discounted_cash": 116.0, "minimum": 18.39, "maximum": 365.0675, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 115.92, "10th_percentile": 115.92, "90th_percentile": 115.92, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 151.79 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 185.99 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 111.67, "10th_percentile": 111.67, "90th_percentile": 111.67, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 148.79 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 185.99 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 185.99 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 205.11, "10th_percentile": 205.11, "90th_percentile": 205.11, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 170.48 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 151.26, "10th_percentile": 109.48, "90th_percentile": 322.0, "count": "1 through 10" }, { "payer_name": "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 322.0, "10th_percentile": 322.0, "90th_percentile": 322.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 103.04, "10th_percentile": 93.38, "90th_percentile": 103.04, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 292.05, "10th_percentile": 292.05, "90th_percentile": 292.05, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 103.04, "10th_percentile": 103.04, "90th_percentile": 103.04, "count": "1 through 10" } ] } ] }, { "description": "COMPLICATED PEPTIC ULCER WITHOUT CCMCC", "code_information": [ { "code": "382", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5380.0, "minimum": 5380.18, "maximum": 9438.26, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9438.26 } ] } ] }, { "description": "HC EVAL,ORAL & PHARYNGEAL SWALLOW FUNCTION, 15 MIN", "code_information": [ { "code": "92610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 620.0, "discounted_cash": 179.0, "minimum": 56.54, "maximum": 562.34, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 56.54, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH MCC", "code_information": [ { "code": "939", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14122.0, "minimum": 14122.96, "maximum": 42776.31, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 42776.31 } ] } ] }, { "description": "Chlorothiazide Sodium For Inj 500 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "63323065894", "type": "NDC" }, { "code": "J1205", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 102.312, "maximum": 1106.89, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1106.89 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 152.58 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 122.07 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 152.58 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 152.58 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 102.31 } ] } ] }, { "description": "HC COMPLETE CBC & AUTO DIFF WBC", "code_information": [ { "code": "85025", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 117.81, "discounted_cash": 34.0, "minimum": 7.77, "maximum": 106.8537, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 63.72, "10th_percentile": 63.72, "90th_percentile": 72.38, "count": "48" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 33.93, "10th_percentile": 32.04, "90th_percentile": 33.93, "count": "230" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 64.16 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 78.62 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 32.69, "10th_percentile": 30.87, "90th_percentile": 32.69, "count": "324" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 62.9 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 78.62 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 78.62 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 60.04, "10th_percentile": 60.04, "90th_percentile": 60.04, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 72.03 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 89.0, "10th_percentile": 8.4, "90th_percentile": 94.25, "count": "66" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 20.69, "10th_percentile": 20.38, "90th_percentile": 21.91, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 94.25, "10th_percentile": 89.0, "90th_percentile": 94.25, "count": "1565" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 30.16, "10th_percentile": 28.48, "90th_percentile": 30.26, "count": "750" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 81.52, "10th_percentile": 81.52, "90th_percentile": 81.52, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 30.16, "10th_percentile": 28.48, "90th_percentile": 32.93, "count": "598" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 30.16, "10th_percentile": 28.48, "90th_percentile": 30.26, "count": "314" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 30.16, "10th_percentile": 28.48, "90th_percentile": 30.26, "count": "296" } ] } ] }, { "description": "HC URINALYSIS", "code_information": [ { "code": "81005", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 68.75, "discounted_cash": 19.0, "minimum": 2.17, "maximum": 62.3563, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.86 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.89 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 17.51 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 21.89 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 21.89 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.12 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2.17, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC INHIBIN A", "code_information": [ { "code": "86336", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 294.69, "discounted_cash": 85.0, "minimum": 15.59, "maximum": 267.2838, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 128.61 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 157.59 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 126.07 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 157.59 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 157.59 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 144.53 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 15.59, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4558) CONDUCTIVE GEL OR PASTE", "code_information": [ { "code": "A4558", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 6.6, "maximum": 6.6, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC IMMUNOASSAY ANALYTE QUANTITATIVE NOS", "code_information": [ { "code": "83520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 468.13, "discounted_cash": 135.0, "minimum": 17.27, "maximum": 424.5939, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 268.14, "10th_percentile": 268.14, "90th_percentile": 268.14, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 134.82, "10th_percentile": 134.82, "90th_percentile": 134.82, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 130.99 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 129.88, "10th_percentile": 129.88, "90th_percentile": 129.88, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 104.79 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 130.99 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 130.99 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 300.01, "10th_percentile": 300.01, "90th_percentile": 300.01, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.1 }, { "payer_name": "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 374.5, "10th_percentile": 195.0, "90th_percentile": 409.0, "count": "15" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 17.27, "10th_percentile": 17.27, "90th_percentile": 119.84, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 17.27, "10th_percentile": 17.27, "90th_percentile": 17.27, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 119.84, "10th_percentile": 119.84, "90th_percentile": 119.84, "count": "1 through 10" } ] } ] }, { "description": "HC MYCOBACT CULTURE,ISOLATN", "code_information": [ { "code": "87116", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 228.75, "discounted_cash": 66.0, "minimum": 10.8, "maximum": 207.4762, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 89.21 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 109.31 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 87.45 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 109.31 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 109.31 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 100.12 }, { "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" } ] } ] }, { "description": "HC ASSAY, AMINOLEVULINIC ACID", "code_information": [ { "code": "82135", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 198.44, "discounted_cash": 57.0, "minimum": 16.45, "maximum": 179.9851, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 135.9 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 166.53 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 133.22 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 166.53 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 166.53 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 152.5 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Cefazolin Sodium For IV Soln 3 GM", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "44567084501", "type": "NDC" }, { "code": "J0690", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2.6145, "maximum": 11.46, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.46 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.9 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3.12 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 3.9 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 3.9 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2.61 } ] } ] }, { "description": "HC (SUP SHELL Q4205) MEMBRANE GRAFT OR WRAP SQ CM", "code_information": [ { "code": "Q4205", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 3326.3055, "maximum": 4960.74, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4960.74 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3968.55 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 4960.74 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 4960.74 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3326.31 } ] } ] }, { "description": "Golimumab IV Soln 50 MG/4ML", "drug_information": { "unit": 4.0, "type": "ML" }, "code_information": [ { "code": "57894035001", "type": "NDC" }, { "code": "J1602", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 33.9255, "maximum": 357.16, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 50.6 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 40.48 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 50.6 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 50.6 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.93 }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 357.16 } ] } ] }, { "description": "HC (SUP SHELL A4565) SLINGS - A4565 - 27400063", "code_information": [ { "code": "A4565", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 10.98, "maximum": 10.98, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 10.98, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC LEPTOSPIRA", "code_information": [ { "code": "86720", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 309.06, "discounted_cash": 89.0, "minimum": 16.2, "maximum": 280.3174, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 71.74 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 87.9 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 70.32 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 87.9 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 87.9 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 150.18 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4428) URINE OST POUCH W FAUCET/TAP", "code_information": [ { "code": "A4428", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 9.29, "maximum": 9.29, "payers_information": [ { "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" } ] } ] }, { "description": "Hydroxyzine HCl Tab 10 MG", "drug_information": { "unit": 100.0, "type": "EA" }, "code_information": [ { "code": "23155050001", "type": "NDC" }, { "code": "Q0177", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 3.68, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.68 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC (SUP SHELL E0749) ELEC OSTEOGEN STIM IMPLANTED", "code_information": [ { "code": "E0749", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 405.26, "maximum": 405.26, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 405.26, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITHOUT CCMCC", "code_information": [ { "code": "538", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5380.0, "minimum": 5380.18, "maximum": 8491.6, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8491.6 } ] } ] }, { "description": "HC X-RAY URETHROCYSTOGRAM & VOIDING", "code_information": [ { "code": "74455", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 970.31, "discounted_cash": 281.0, "minimum": 281.3899, "maximum": 880.0712, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 294.67 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 361.07 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 288.86 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 361.07 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 361.07 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 750.05 } ] } ] }, { "description": "AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC", "code_information": [ { "code": "269", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3362.0, "minimum": 3362.61, "maximum": 49787.22, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 49787.22 } ] } ] }, { "description": "HC SALIVARY GLAND IMAGING", "code_information": [ { "code": "78230", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 947.19, "discounted_cash": 274.0, "minimum": 274.6851, "maximum": 947.19, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 532.47 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 652.46 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 521.97 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 652.46 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 652.46 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 947.19 } ] } ] }, { "description": "HC LYMPHANGIOGRAPHY PELVIC/ABDOMIN, UNILAT", "code_information": [ { "code": "75805", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12169.1, "discounted_cash": 3529.0, "minimum": 948.13, "maximum": 11037.3737, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 967.22 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1185.17 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 948.13 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1185.17 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1185.17 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1821.55 } ] } ] }, { "description": "VIRAL ILLNESS WITHOUT MCC", "code_information": [ { "code": "866", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6052.0, "minimum": 6052.7, "maximum": 10251.7, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10251.7 } ] } ] }, { "description": "HC NM LIVER IMAGING WITH FLOW", "code_information": [ { "code": "78202", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 645.63, "discounted_cash": 187.0, "minimum": 187.2327, "maximum": 645.63, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 645.63 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 645.63 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 645.63 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 645.63 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 645.63 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 645.63 } ] } ] }, { "description": "OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC", "code_information": [ { "code": "229", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5380.0, "minimum": 5380.18, "maximum": 37129.39, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 37129.39 } ] } ] }, { "description": "LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC", "code_information": [ { "code": "417", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10536.0, "minimum": 10536.18, "maximum": 28133.22, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28133.22 } ] } ] }, { "description": "SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC", "code_information": [ { "code": "574", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17037.0, "minimum": 17037.22, "maximum": 40924.27, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 40924.27 } ] } ] }, { "description": "Terbutaline Sulfate Inj 1 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00143974601", "type": "NDC" }, { "code": "J3105", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 4.4415, "maximum": 42.63, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 42.63 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.62 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.3 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 6.62 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 6.62 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.44 } ] } ] }, { "description": "MINOR BLADDER PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "664", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4707.0, "minimum": 4707.65, "maximum": 12341.88, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12341.88 } ] } ] }, { "description": "HC CT GUIDANCE NEEDLE PLACEMENT", "code_information": [ { "code": "77012", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2223.44, "discounted_cash": 644.0, "minimum": 559.16, "maximum": 2016.6601, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 570.41 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 698.95 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 559.16 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 698.95 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 698.95 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 597.76 } ] } ] }, { "description": "HC US,TRANSPLANTED KIDNEY, REAL TIME/ DOPPLER", "code_information": [ { "code": "76776", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1562.81, "discounted_cash": 453.0, "minimum": 420.42, "maximum": 1417.4687, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 525.53 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 420.42 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 525.53 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 525.53 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 947.41 } ] } ] }, { "description": "HAND PROCEDURES FOR INJURIES", "code_information": [ { "code": "906", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6276.0, "minimum": 6276.87, "maximum": 23157.09, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23157.09 } ] } ] }, { "description": "INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CCMCC", "code_information": [ { "code": "066", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4259.0, "minimum": 4259.31, "maximum": 8068.38, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8068.38 } ] } ] }, { "description": "HC ARC RBC PRETREATMENT,SERUM DILUTN", "code_information": [ { "code": "86976", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 52.19, "discounted_cash": 15.0, "minimum": 15.1351, "maximum": 52.19, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 52.19 } ] } ] }, { "description": "RENAL FAILURE WITH MCC", "code_information": [ { "code": "682", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9639.0, "minimum": 6588.4219, "maximum": 17459.48, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17459.48 } ] } ] }, { "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", "minimum": 28.4, "maximum": 28.4, "payers_information": [ { "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" } ] } ] }, { "description": "HC HEMOGLOBIN CHROMOTOGRAPHY", "code_information": [ { "code": "83021", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 102.81, "discounted_cash": 29.0, "minimum": 18.06, "maximum": 102.81, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 102.81 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 102.81 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 102.81 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 102.81 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 102.81 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 217.5, "10th_percentile": 217.5, "90th_percentile": 217.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 197.27, "10th_percentile": 197.27, "90th_percentile": 199.23, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL A6252) ABSORPT DRG >16 <=48 W/O BDR - A6252 - 27200141", "code_information": [ { "code": "A6252", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 4.64, "maximum": 4.64, "payers_information": [ { "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" } ] } ] }, { "description": "HC CT SCAN OF ABDOMEN COMBO", "code_information": [ { "code": "74170", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3903.13, "discounted_cash": 1131.0, "minimum": 650.0, "maximum": 3540.1389, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 2250.02, "10th_percentile": 2250.02, "90th_percentile": 2250.02, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 1045.17, "10th_percentile": 1045.17, "90th_percentile": 1107.9, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1689.29 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 1067.28, "10th_percentile": 1067.28, "90th_percentile": 1067.28, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1351.43 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1689.29 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1689.29 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 2418.92, "10th_percentile": 2418.92, "90th_percentile": 2418.92, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1722.87 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 904.61, "10th_percentile": 904.61, "90th_percentile": 904.61, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 3077.5, "10th_percentile": 3077.5, "90th_percentile": 3077.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 929.04, "10th_percentile": 929.04, "90th_percentile": 987.11, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 2791.29, "10th_percentile": 2791.29, "90th_percentile": 2791.29, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 929.04, "10th_percentile": 929.04, "90th_percentile": 984.8, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 984.8, "10th_percentile": 984.8, "90th_percentile": 987.11, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 984.8, "10th_percentile": 929.04, "90th_percentile": 984.8, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL C2616) Y90 BRACHYTHERAPY", "code_information": [ { "code": "C2616", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 55078.065, "maximum": 55078.065, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 55078.07 } ] } ] }, { "description": "HC ASSAY OF CARBAMAZEPINE TOTAL", "code_information": [ { "code": "80156", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 239.06, "discounted_cash": 69.0, "minimum": 14.57, "maximum": 216.8274, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 68.85, "10th_percentile": 68.85, "90th_percentile": 68.85, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 120.18 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 147.27 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 117.81 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 147.27 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 147.27 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 135.07 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 114.15, "10th_percentile": 114.15, "90th_percentile": 114.15, "count": "1 through 10" }, { "payer_name": "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 Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 61.2, "10th_percentile": 57.76, "90th_percentile": 61.2, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 61.2, "10th_percentile": 61.2, "90th_percentile": 61.2, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL A6248) HYDROGEL DRSG GEL FILLER - A6248 - RU272052", "code_information": [ { "code": "A6248", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 23.15, "maximum": 56.04, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 56.04 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 44.84 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 56.04 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 56.04 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 23.15, "additional_payer_notes": "100.00% 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": 16140.0, "minimum": 16140.53, "maximum": 65619.82, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 65619.82 } ] } ] }, { "description": "HC MRA CHEST W CONTRAST, EXCLUDE HEART - C8909 - 61800004", "code_information": [ { "code": "C8909", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3750.94, "minimum": 900.0, "maximum": 3402.1026, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 } ] } ] }, { "description": "HC CYTOGENETICS 100-300", "code_information": [ { "code": "88275", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1231.56, "discounted_cash": 357.0, "minimum": 51.19, "maximum": 1117.0249, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 331.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 406.2 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 324.96 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 406.2 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 406.2 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 474.56 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 51.19, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC ANTIBODY TREPONEMA PALLIDUM", "code_information": [ { "code": "86780", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 272.19, "discounted_cash": 78.0, "minimum": 13.24, "maximum": 246.8763, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 107.24 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 131.41 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 105.12 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 131.41 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 131.41 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 122.74 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY THOR-LUMB SP 2 VW", "code_information": [ { "code": "72080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 639.69, "discounted_cash": 185.0, "minimum": 94.37, "maximum": 580.1988, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 173.79, "10th_percentile": 173.79, "90th_percentile": 173.79, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 96.27 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 117.96 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 94.37 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 117.96 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 117.96 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 208.63 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 511.75, "10th_percentile": 511.75, "90th_percentile": 511.75, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 154.47, "10th_percentile": 154.47, "90th_percentile": 154.47, "count": "1 through 10" } ] } ] }, { "description": "Propofol IV Emul 1000 MG/100ML (10 MG/ML)", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "63323026935", "type": "NDC" }, { "code": "J2704", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.76, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.76 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "MAJOR CHEST TRAUMA WITHOUT CCMCC", "code_information": [ { "code": "185", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5156.0, "minimum": 5156.0, "maximum": 9272.03, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9272.03 } ] } ] }, { "description": "HC (SUP SHELL A4320) IRRIGATION TRAY", "code_information": [ { "code": "A4320", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 7.61, "maximum": 7.61, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7.61, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC LYMPHATICS & LYMPH GLANDS IMAGING", "code_information": [ { "code": "78195", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1480.63, "discounted_cash": 429.0, "minimum": 429.3827, "maximum": 1480.63, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1062.03 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1301.35 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1041.08 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1301.35 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1301.35 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1480.63 } ] } ] }, { "description": "OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH CC", "code_information": [ { "code": "357", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9863.0, "minimum": 9863.66, "maximum": 27415.27, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27415.27 } ] } ] }, { "description": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "834", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21520.0, "minimum": 21520.7, "maximum": 64720.32, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 64720.32 } ] } ] }, { "description": "HC CORTISOL, FREE", "code_information": [ { "code": "82530", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 69.38, "discounted_cash": 20.0, "minimum": 16.71, "maximum": 69.38, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 69.38 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 69.38 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 69.38 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 69.38 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 69.38 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 35.35, "10th_percentile": 35.35, "90th_percentile": 35.35, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 69.38 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 55.5, "10th_percentile": 55.5, "90th_percentile": 55.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 16.71, "10th_percentile": 16.71, "90th_percentile": 16.71, "count": "1 through 10" } ] } ] }, { "description": "HC CT SCAN LUMBAR SPINE WO CONTRAST", "code_information": [ { "code": "72131", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2379.69, "discounted_cash": 690.0, "minimum": 650.0, "maximum": 2158.3788, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 1391.9, "10th_percentile": 1391.9, "90th_percentile": 1462.08, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 963.52 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 660.23, "10th_percentile": 622.85, "90th_percentile": 660.23, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 770.82 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 963.52 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 963.52 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 724.71 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1903.75, "10th_percentile": 1796.0, "90th_percentile": 1903.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 574.72, "10th_percentile": 574.72, "90th_percentile": 609.2, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 609.2, "10th_percentile": 609.2, "90th_percentile": 609.2, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 609.2, "10th_percentile": 574.72, "90th_percentile": 610.64, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL Q4132) GRAFIX CORE, GRAFIXPL CORE", "code_information": [ { "code": "Q4132", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 118.125, "maximum": 1968.08, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1968.08 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 176.17 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 140.93 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 176.17 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 176.17 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 118.13 } ] } ] }, { "description": "HC ANGIO PULMON BILAT SELECT", "code_information": [ { "code": "75743", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9589.06, "discounted_cash": 2780.0, "minimum": 609.0963, "maximum": 8697.2774, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 875.32 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1072.56 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 858.05 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1072.56 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1072.56 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 609.1 } ] } ] }, { "description": "HC CT HEART CONTRAST EVAL CARDIAC STRUCT/MORPH", "code_information": [ { "code": "75572", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1814.06, "discounted_cash": 526.0, "minimum": 526.0774, "maximum": 1645.3524, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 881.3 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 705.03 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 881.3 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 881.3 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1288.67 } ] } ] }, { "description": "HC ASSAY OF SERUM SODIUM", "code_information": [ { "code": "84295", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 47.19, "discounted_cash": 13.0, "minimum": 4.81, "maximum": 47.19, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 39.68 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 47.19 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 38.9 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 47.19 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 47.19 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.59 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 35.6, "10th_percentile": 35.6, "90th_percentile": 35.6, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 12.08, "10th_percentile": 12.08, "90th_percentile": 13.97, "count": "1 through 10" } ] } ] }, { "description": "HC HEPATITIS, DELTA AGENT", "code_information": [ { "code": "86692", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 319.38, "discounted_cash": 92.0, "minimum": 17.16, "maximum": 289.6777, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 139.52 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 170.96 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 136.77 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 170.96 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 170.96 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 159.08 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 17.16, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC SYPHILIS TEST NON TREPONEMAL ANTIBODY QUAL", "code_information": [ { "code": "86592", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 111.56, "discounted_cash": 32.0, "minimum": 4.27, "maximum": 101.1849, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 68.54, "10th_percentile": 65.29, "90th_percentile": 68.54, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 32.13, "10th_percentile": 32.13, "90th_percentile": 32.13, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 35.22 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 43.16 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 34.52 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 43.16 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 43.16 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 53.67, "10th_percentile": 53.67, "90th_percentile": 53.67, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 67.49, "10th_percentile": 67.49, "90th_percentile": 67.49, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.59 }, { "payer_name": "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 4.27, "10th_percentile": 4.27, "90th_percentile": 4.27, "count": "64" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 26.96, "10th_percentile": 26.96, "90th_percentile": 28.56, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 80.95, "10th_percentile": 77.17, "90th_percentile": 80.95, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 28.56, "10th_percentile": 28.56, "90th_percentile": 28.56, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 28.56, "10th_percentile": 28.56, "90th_percentile": 28.56, "count": "1 through 10" } ] } ] }, { "description": "HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC", "code_information": [ { "code": "420", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15468.0, "minimum": 15468.01, "maximum": 40166.23, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 40166.23 } ] } ] }, { "description": "HC CT SCAN,LIMITED/LOCALIZED F/U STUDY", "code_information": [ { "code": "76380", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 801.56, "discounted_cash": 232.0, "minimum": 232.4524, "maximum": 755.7193, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 520.17 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 416.14 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 520.17 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 520.17 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 755.72 } ] } ] }, { "description": "HC STANDARDIZED COGNITIVE PERFORMANCE TESTING", "code_information": [ { "code": "96125", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 300.31, "discounted_cash": 87.0, "minimum": 87.0899, "maximum": 272.3812, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 98.79, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC MYOCRD STRAIN IMG SPECKLE TRCK ASSMT MYOCRD MECH (93356)", "code_information": [ { "code": "93356", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 52.5, "discounted_cash": 15.0, "minimum": 15.225, "maximum": 47.6175, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 28.64, "10th_percentile": 28.64, "90th_percentile": 28.64, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 25.62, "10th_percentile": 25.62, "90th_percentile": 26.11, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 13.87, "10th_percentile": 13.87, "90th_percentile": 13.87, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 40.0, "10th_percentile": 40.0, "90th_percentile": 40.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 40.0, "10th_percentile": 40.0, "90th_percentile": 40.0, "count": "13" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 12.8, "10th_percentile": 12.8, "90th_percentile": 12.8, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 36.28, "10th_percentile": 36.28, "90th_percentile": 36.28, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 863.13, "10th_percentile": 801.91, "90th_percentile": 863.13, "count": "12" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 12.8, "10th_percentile": 12.8, "90th_percentile": 12.8, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 12.8, "10th_percentile": 12.8, "90th_percentile": 12.8, "count": "1 through 10" } ] } ] }, { "description": "CHOLECYSTECTOMY WITH C.D.E. WITHOUT CCMCC", "code_information": [ { "code": "413", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6052.0, "minimum": 6052.7, "maximum": 19575.6, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19575.6 } ] } ] }, { "description": "TRAUMATIC INJURY WITH MCC", "code_information": [ { "code": "913", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8742.0, "minimum": 8742.79, "maximum": 19270.27, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19270.27 } ] } ] }, { "description": "HC ASSAY OF PROLACTIN", "code_information": [ { "code": "84146", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 242.81, "discounted_cash": 70.0, "minimum": 19.38, "maximum": 220.2287, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 159.98 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 196.03 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 156.83 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 196.03 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 196.03 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 123.74, "10th_percentile": 123.74, "90th_percentile": 123.74, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 179.66 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 40.4, "10th_percentile": 40.4, "90th_percentile": 40.4, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 194.25, "10th_percentile": 194.25, "90th_percentile": 194.25, "count": "18" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 62.16, "10th_percentile": 62.16, "90th_percentile": 66.05, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 176.18, "10th_percentile": 176.18, "90th_percentile": 176.18, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 62.16, "10th_percentile": 62.16, "90th_percentile": 71.87, "count": "1 through 10" } ] } ] }, { "description": "O.R. PROCEDURES FOR OBESITY WITH MCC", "code_information": [ { "code": "619", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6276.0, "minimum": 6276.87, "maximum": 34039.5, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34039.5 } ] } ] }, { "description": "HC MOLECULAR PATHOLOGY PROCEDURE LEVEL 4", "code_information": [ { "code": "81403", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2329.69, "discounted_cash": 675.0, "minimum": 185.2, "maximum": 2113.0288, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1556.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1907.56 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1526.05 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1907.56 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1907.56 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1716.9 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 185.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARREST, UNEXPLAINED WITHOUT CCMCC", "code_information": [ { "code": "298", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 2465.0, "minimum": 2465.91, "maximum": 5365.16, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 5365.16 } ] } ] }, { "description": "HC (SUP SHELL A6021) COLLAGEN DRESSING <=16 SQ IN - A6021 - 27200109", "code_information": [ { "code": "A6021", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 29.97, "maximum": 29.97, "payers_information": [ { "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" } ] } ] }, { "description": "BONE DISEASES AND ARTHROPATHIES WITHOUT MCC", "code_information": [ { "code": "554", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6276.0, "minimum": 6276.87, "maximum": 49367.718, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9786.03 } ] } ] }, { "description": "SINUS AND MASTOID PROCEDURES WITH CCMCC", "code_information": [ { "code": "135", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8070.0, "minimum": 8070.26, "maximum": 25582.09, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25582.09 } ] } ] }, { "description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CCMCC", "code_information": [ { "code": "434", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5156.0, "minimum": 5156.0, "maximum": 8399.65, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8399.65 } ] } ] }, { "description": "MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "331", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6052.0, "minimum": 6052.7, "maximum": 19839.67, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19839.67 } ] } ] }, { "description": "Nitroglycerin IV Soln 400 MCG/ML in D5W", "drug_information": { "unit": 250.0, "type": "ML" }, "code_information": [ { "code": "00338105102", "type": "NDC" }, { "code": "J2305", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 4.221, "maximum": 6.3, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.3 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.04 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 6.3 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 6.3 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.22 } ] } ] }, { "description": "HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL - 84153 - 30100312", "code_information": [ { "code": "84153", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 231.25, "discounted_cash": 67.0, "minimum": 18.39, "maximum": 209.7438, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 132.46, "10th_percentile": 132.46, "90th_percentile": 132.46, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 66.6, "10th_percentile": 66.6, "90th_percentile": 66.6, "count": "26" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 151.79 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 185.99 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 64.16, "10th_percentile": 64.16, "90th_percentile": 64.16, "count": "17" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 148.79 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 185.99 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 185.99 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 117.85, "10th_percentile": 117.85, "90th_percentile": 117.85, "count": "13" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 148.2, "10th_percentile": 145.41, "90th_percentile": 148.2, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 170.48 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 44.16, "10th_percentile": 37.44, "90th_percentile": 158.49, "count": "20" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 42.37, "10th_percentile": 42.37, "90th_percentile": 42.37, "count": "1 through 10" }, { "payer_name": "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 185.0, "10th_percentile": 185.0, "90th_percentile": 185.0, "count": "31" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 59.2, "10th_percentile": 59.2, "90th_percentile": 62.9, "count": "54" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 167.8, "10th_percentile": 147.87, "90th_percentile": 169.46, "count": "17" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 59.2, "10th_percentile": 59.2, "90th_percentile": 59.2, "count": "36" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 59.2, "10th_percentile": 59.2, "90th_percentile": 62.9, "count": "15" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 59.2, "10th_percentile": 59.2, "90th_percentile": 62.9, "count": "1 through 10" } ] } ] }, { "description": "HC X-RAY ANKLE 3+ VW", "code_information": [ { "code": "73610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 483.44, "discounted_cash": 140.0, "minimum": 85.8, "maximum": 438.4801, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 261.16, "10th_percentile": 261.16, "90th_percentile": 261.16, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 131.31, "10th_percentile": 131.31, "90th_percentile": 139.23, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 87.53 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 107.26 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 134.13, "10th_percentile": 126.5, "90th_percentile": 134.13, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 85.8 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 107.26 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 107.26 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 246.36, "10th_percentile": 246.36, "90th_percentile": 246.36, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 303.99, "10th_percentile": 303.99, "90th_percentile": 303.99, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 239.7 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 123.76, "10th_percentile": 123.76, "90th_percentile": 123.76, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 386.75, "10th_percentile": 364.75, "90th_percentile": 386.75, "count": "85" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 123.76, "10th_percentile": 116.72, "90th_percentile": 123.76, "count": "15" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 334.12, "10th_percentile": 334.11, "90th_percentile": 350.78, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 123.76, "10th_percentile": 116.72, "90th_percentile": 134.96, "count": "19" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 123.76, "10th_percentile": 116.72, "90th_percentile": 124.02, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 123.76, "10th_percentile": 116.72, "90th_percentile": 124.02, "count": "1 through 10" } ] } ] }, { "description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "027", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3362.0, "minimum": 3362.61, "maximum": 29742.42, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 29742.42 } ] } ] }, { "description": "Potassium Chloride Inj 10 mEq/100ML", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "00338070948", "type": "NDC" }, { "code": "J3480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.76, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 62.35, "10th_percentile": 62.35, "90th_percentile": 62.35, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.76 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "AFTERCARE WITH CCMCC", "code_information": [ { "code": "949", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9639.0, "minimum": 9639.48, "maximum": 38157.8296, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 9639.48, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 9749.6, "10th_percentile": 9749.6, "90th_percentile": 13649.44, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14025.35 } ] } ] }, { "description": "HC EXAM & SELECT ARCHIVE TISSUE MOLECULAR ANALYSIS", "code_information": [ { "code": "88363", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 151.88, "discounted_cash": 44.0, "minimum": 44.0452, "maximum": 151.88, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 151.88 } ] } ] }, { "description": "Diphenhydramine HCl Cap 25 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "68094001859", "type": "NDC" }, { "code": "Q0163", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 3.99, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC CT SCAN,SOFT TISSUE NECK,W/O CONTRAST", "code_information": [ { "code": "70490", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1630.94, "discounted_cash": 472.0, "minimum": 472.9726, "maximum": 1479.2626, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 443.16, "10th_percentile": 443.16, "90th_percentile": 443.16, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 963.52 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 770.82 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 963.52 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 963.52 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 792.32 } ] } ] }, { "description": "MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "508", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7173.0, "minimum": 7173.57, "maximum": 17853.23, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17853.23 } ] } ] }, { "description": "Labetalol HCl IV Soln 5 MG/ML", "drug_information": { "unit": 20.0, "type": "ML" }, "code_information": [ { "code": "00143962201", "type": "NDC" }, { "code": "J1920", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.323, "maximum": 1.97, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.97 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.58 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.97 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.97 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.32 } ] } ] }, { "description": "Dexamethasone Sodium Phosphate Inj 4 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "63323016502", "type": "NDC" }, { "code": "J1100", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.76, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 15.47, "10th_percentile": 13.54, "90th_percentile": 25.78, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.76 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC X-RAY LUMBAR SPINE FLEX/EXTEN", "code_information": [ { "code": "72120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 693.13, "discounted_cash": 201.0, "minimum": 145.88, "maximum": 628.6689, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 148.81 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 182.35 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 145.88 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 182.35 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 182.35 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 253.77 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 502.93, "10th_percentile": 502.93, "90th_percentile": 502.93, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 177.82, "10th_percentile": 177.82, "90th_percentile": 177.82, "count": "1 through 10" } ] } ] }, { "description": "Iron Dextran Inj 50 MG/ML (Elemental Iron)", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "00023608201", "type": "NDC" }, { "code": "J1750", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 54.2745, "maximum": 200.93, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 200.93 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 80.94 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 64.75 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 80.94 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 80.94 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 54.27 } ] } ] }, { "description": "HC MR ANGIO, NECK W/CONTRAST", "code_information": [ { "code": "70548", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2180.63, "discounted_cash": 632.0, "minimum": 632.3827, "maximum": 2118.32, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2118.32 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1694.64 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2118.32 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2118.32 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1548.04 } ] } ] }, { "description": "HC US NRV&ACC STRUX 1XTR COMPRE", "code_information": [ { "code": "76883", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5872.19, "discounted_cash": 1702.0, "minimum": 121.2183, "maximum": 5326.0763, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 121.22 } ] } ] }, { "description": "HC PROTEIN, WESTERN BLOT TEST, W BAND ID", "code_information": [ { "code": "84182", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 602.19, "discounted_cash": 174.0, "minimum": 29.21, "maximum": 546.1863, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 148.56 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 182.04 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 145.63 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 182.04 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 182.04 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 270.79 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 29.21, "additional_payer_notes": "100.00% 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": 473.0, "minimum": 473.8774, "maximum": 1482.0924, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 943.88 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1156.58 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 925.26 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1156.58 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1156.58 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 845.93 } ] } ] }, { "description": "HC DRUG SCREEN QUANT ALCOHOLS BIOMARKERS 1 OR 2 - 80321 - 31080321", "code_information": [ { "code": "80321", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 478.13, "discounted_cash": 138.0, "minimum": 124.8736, "maximum": 433.6639, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 124.87 }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 122.4, "10th_percentile": 122.4, "90th_percentile": 122.4, "count": "1 through 10" } ] } ] }, { "description": "HC COLLECT BLD ESTABLISHED CATH", "code_information": [ { "code": "36592", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 39.38, "discounted_cash": 11.0, "minimum": 11.4202, "maximum": 35.7177, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 31.5, "10th_percentile": 31.5, "90th_percentile": 31.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 30.0, "10th_percentile": 30.0, "90th_percentile": 30.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 10.08, "10th_percentile": 10.08, "90th_percentile": 10.08, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 10.2, "10th_percentile": 10.2, "90th_percentile": 10.2, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 10.2, "10th_percentile": 10.2, "90th_percentile": 10.2, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL A5051) POUCH CLSD W BARR ATTACHED", "code_information": [ { "code": "A5051", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2.94, "maximum": 2.94, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2.94, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A5057) 1 PC OST POU W BUILT-IN CONV", "code_information": [ { "code": "A5057", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 13.68, "maximum": 13.68, "payers_information": [ { "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" } ] } ] }, { "description": "HC X-RAY EXAM OF FINGER(S)", "code_information": [ { "code": "73140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 393.44, "discounted_cash": 114.0, "minimum": 84.38, "maximum": 356.8501, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 212.65, "10th_percentile": 212.65, "90th_percentile": 230.18, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 106.92, "10th_percentile": 106.92, "90th_percentile": 113.31, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 86.08 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 105.47 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 84.38 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 105.47 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 105.47 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 267.91 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 44.01, "10th_percentile": 44.01, "90th_percentile": 314.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 314.75, "10th_percentile": 297.0, "90th_percentile": 314.75, "count": "33" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 100.72, "10th_percentile": 95.04, "90th_percentile": 100.98, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 272.05, "10th_percentile": 272.05, "90th_percentile": 285.48, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 100.72, "10th_percentile": 95.04, "90th_percentile": 100.72, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 100.72, "10th_percentile": 100.72, "90th_percentile": 100.98, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 100.72, "10th_percentile": 100.72, "90th_percentile": 100.98, "count": "1 through 10" } ] } ] }, { "description": "PLEURAL EFFUSION WITHOUT CCMCC", "code_information": [ { "code": "188", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4707.0, "minimum": 4707.65, "maximum": 8455.06, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8455.06 } ] } ] }, { "description": "HC (SUP SHELL V2628) FABRICATION & FITTING", "code_information": [ { "code": "V2628", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 372.48, "maximum": 372.48, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 372.48, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY EYE FOR FOREIGN BODY", "code_information": [ { "code": "70030", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 423.75, "discounted_cash": 122.0, "minimum": 75.77, "maximum": 384.3413, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 77.3 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 94.72 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 75.77 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 94.72 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 94.72 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 205.83 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 339.0, "10th_percentile": 339.0, "90th_percentile": 339.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 307.47, "10th_percentile": 307.47, "90th_percentile": 307.47, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 108.48, "10th_percentile": 108.48, "90th_percentile": 108.48, "count": "1 through 10" } ] } ] }, { "description": "HC NM LIVER IMAGING", "code_information": [ { "code": "78201", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1705.0, "discounted_cash": 494.0, "minimum": 494.45, "maximum": 1546.435, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 596.66 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 731.12 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 584.89 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 731.12 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 731.12 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1328.14 } ] } ] }, { "description": "OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC", "code_information": [ { "code": "394", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6501.0, "minimum": 6501.05, "maximum": 11030.95, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "other", "standard_charge_dollar": 6793.6, "standard_charge_algorithm": "2342.62 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 7933.54, "10th_percentile": 7933.54, "90th_percentile": 16153.46, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11030.95 } ] } ] }, { "description": "HC PARAFFIN BATH THERAPY", "code_information": [ { "code": "97018", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 89.06, "discounted_cash": 25.0, "minimum": 5.59, "maximum": 89.06, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 89.06 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.59, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "VENTRICULAR SHUNT PROCEDURES WITH CC", "code_information": [ { "code": "032", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5604.0, "minimum": 5604.35, "maximum": 25122.32, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25122.32 } ] } ] }, { "description": "HC MRI GUIDANCE NEEDLE PLACEMENT", "code_information": [ { "code": "77021", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1250.0, "discounted_cash": 362.0, "minimum": 362.5, "maximum": 1250.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1250.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1250.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1250.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1250.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1250.0 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1250.0 } ] } ] }, { "description": "VAGINA, CERVIX AND VULVA PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "747", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 2914.0, "minimum": 2914.26, "maximum": 10134.99, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10134.99 } ] } ] }, { "description": "HC DRUG SCREEN QUANT CLOZAPINE", "code_information": [ { "code": "80159", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 106.56, "discounted_cash": 30.0, "minimum": 20.15, "maximum": 106.56, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 106.56 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 106.56 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 106.56 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 106.56 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 106.56 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 106.56 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 36.51, "10th_percentile": 32.48, "90th_percentile": 80.5, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 20.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 17.66, "10th_percentile": 17.66, "90th_percentile": 17.66, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 25.76, "10th_percentile": 25.76, "90th_percentile": 25.76, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 27.28, "10th_percentile": 25.76, "90th_percentile": 27.28, "count": "15" } ] } ] }, { "description": "HC OCCULT BLOOD OTHER SOURCES", "code_information": [ { "code": "82271", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 61.88, "discounted_cash": 17.0, "minimum": 5.32, "maximum": 56.1252, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 26.85 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 32.9 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 32.9 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 32.9 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 49.32 }, { "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" } ] } ] }, { "description": "HC MRI, DORSAL SPINE COMBO", "code_information": [ { "code": "72157", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3195.63, "discounted_cash": 926.0, "minimum": 900.0, "maximum": 2898.4364, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2670.71 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2136.55 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2670.71 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2670.71 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1880.76 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 2556.5, "10th_percentile": 2556.5, "90th_percentile": 2556.5, "count": "1 through 10" } ] } ] }, { "description": "CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC", "code_information": [ { "code": "235", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17933.0, "minimum": 17933.92, "maximum": 69184.81, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 69184.81 } ] } ] }, { "description": "HC X-RAY GALLBLADDER W ORAL CONTRAST", "code_information": [ { "code": "74290", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 850.63, "discounted_cash": 246.0, "minimum": 188.78, "maximum": 771.5214, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 192.58 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 235.97 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 188.78 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 235.97 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 235.97 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 592.16 } ] } ] }, { "description": "Levofloxacin in D5W IV Soln 750 MG/150ML", "drug_information": { "unit": 150.0, "type": "ML" }, "code_information": [ { "code": "00143972001", "type": "NDC" }, { "code": "J1956", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 3.2445, "maximum": 18.36, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.36 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.79 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3.83 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 4.79 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 4.79 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.24 } ] } ] }, { "description": "HC BLOOD CLOT FACTOR IX TEST", "code_information": [ { "code": "85250", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 723.13, "discounted_cash": 209.0, "minimum": 19.04, "maximum": 655.8789, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 157.1 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 192.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 154.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 192.5 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 192.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 176.51 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 19.04, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Phenobarbital Sodium Inj 130 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00641047721", "type": "NDC" }, { "code": "J2560", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 92.736, "maximum": 561.04, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 561.04 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 138.3 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 110.64 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 138.3 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 138.3 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 92.74 } ] } ] }, { "description": "HC ASSAY OF ESTROGENS", "code_information": [ { "code": "82671", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 438.13, "discounted_cash": 127.0, "minimum": 32.3, "maximum": 397.3839, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 266.54 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 326.61 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 261.29 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 326.61 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 326.61 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 299.44 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 112.16, "10th_percentile": 112.16, "90th_percentile": 112.16, "count": "1 through 10" } ] } ] }, { "description": "Ceftriaxone Sodium For Inj 500 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "60505615204", "type": "NDC" }, { "code": "J0696", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.5435, "maximum": 8.66, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 12.77, "10th_percentile": 12.77, "90th_percentile": 12.77, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.66 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2.3 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.84 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2.3 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2.3 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.54 } ] } ] }, { "description": "HC (SUP SHELL Q4114) INTEGRA FLOWABLE WOUND MATRIX", "code_information": [ { "code": "Q4114", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 4707.2025, "maximum": 24907.55, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 24907.55 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7020.16 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5616.07 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 7020.16 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 7020.16 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4707.2 } ] } ] }, { "description": "HC SPEECH/HEARING THERAPY, GROUP, 15 MIN", "code_information": [ { "code": "92508", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 343.13, "discounted_cash": 99.0, "minimum": 22.91, "maximum": 311.2189, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 22.91, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY WITH C.D.E. WITH CC", "code_information": [ { "code": "412", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8518.0, "minimum": 8518.61, "maximum": 24786.33, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24786.33 } ] } ] }, { "description": "HC (SUP SHELL L3905) WHO W/NONTORSION JNT(S) CF", "code_information": [ { "code": "L3905", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1082.62, "maximum": 1082.62, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1082.62, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSESSMENT OF APHASIA", "code_information": [ { "code": "96105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 517.5, "discounted_cash": 150.0, "minimum": 93.6, "maximum": 469.3725, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 93.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "SPLENIC PROCEDURES WITH MCC", "code_information": [ { "code": "799", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15243.0, "minimum": 15243.83, "maximum": 53391.11, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 53391.11 } ] } ] }, { "description": "LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH MCC", "code_information": [ { "code": "492", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14795.0, "minimum": 14795.48, "maximum": 43284.42, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 43284.42 } ] } ] }, { "description": "HC (SUP SHELL L3925) FO PIP DIP JNT/SPRNG PRE OTS", "code_information": [ { "code": "L3925", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 58.68, "maximum": 58.68, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 58.68, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AICD LEAD PROCEDURES", "code_information": [ { "code": "265", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9863.0, "minimum": 9863.66, "maximum": 42654.89, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 42654.89 } ] } ] }, { "description": "CONCUSSION WITH CC", "code_information": [ { "code": "089", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5604.0, "minimum": 5604.35, "maximum": 12951.37, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12951.37 } ] } ] }, { "description": "VENTRICULAR SHUNT PROCEDURES WITH MCC", "code_information": [ { "code": "031", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15692.0, "minimum": 15692.18, "maximum": 52820.52, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 52820.52 } ] } ] }, { "description": "Heparin Sodium (Porcine) Lock Flush PF IV Soln 10 Unit/ML", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "64253022235", "type": "NDC" }, { "code": "J1642", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 2.65, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2.65 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC PROTHROMBIN TIME", "code_information": [ { "code": "85610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 99.69, "discounted_cash": 28.0, "minimum": 4.29, "maximum": 90.4188, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 51.37, "10th_percentile": 51.37, "90th_percentile": 61.25, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 28.71, "10th_percentile": 25.83, "90th_percentile": 28.71, "count": "29" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 32.45 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 39.76 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 27.66, "10th_percentile": 24.89, "90th_percentile": 27.66, "count": "130" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 31.81 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 39.76 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 39.76 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 50.8, "10th_percentile": 50.8, "90th_percentile": 50.8, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 62.68, "10th_percentile": 57.48, "90th_percentile": 62.68, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.77 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 3.76, "10th_percentile": 3.28, "90th_percentile": 71.75, "count": "38" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 79.75, "10th_percentile": 71.75, "90th_percentile": 79.75, "count": "197" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 24.4, "10th_percentile": 14.08, "90th_percentile": 25.52, "count": "209" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 65.72, "10th_percentile": 65.72, "90th_percentile": 65.72, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 25.52, "10th_percentile": 22.96, "90th_percentile": 26.55, "count": "187" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 25.52, "10th_percentile": 22.96, "90th_percentile": 25.52, "count": "47" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 25.52, "10th_percentile": 22.96, "90th_percentile": 25.52, "count": "164" } ] } ] }, { "description": "HC HEMOGLOBIN", "code_information": [ { "code": "85018", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 45.94, "discounted_cash": 13.0, "minimum": 2.37, "maximum": 41.6676, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 29.54, "10th_percentile": 29.54, "90th_percentile": 29.54, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 13.23, "10th_percentile": 12.51, "90th_percentile": 15.75, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 19.56 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.97 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 12.75, "10th_percentile": 12.06, "90th_percentile": 15.18, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 19.17 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 23.97 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 23.97 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 22.14, "10th_percentile": 22.14, "90th_percentile": 22.14, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.97 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 36.75, "10th_percentile": 36.75, "90th_percentile": 39.74, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 41.25, "10th_percentile": 34.75, "90th_percentile": 43.75, "count": "24" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 11.76, "10th_percentile": 11.12, "90th_percentile": 13.2, "count": "19" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 27.78, "10th_percentile": 27.78, "90th_percentile": 39.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 11.76, "10th_percentile": 11.12, "90th_percentile": 12.86, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 11.76, "10th_percentile": 11.76, "90th_percentile": 11.76, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 11.76, "10th_percentile": 11.12, "90th_percentile": 11.82, "count": "27" } ] } ] }, { "description": "Hydralazine HCl Inj 20 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "63323061400", "type": "NDC" }, { "code": "J0360", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 13.86, "maximum": 41.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 41.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.67 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 16.54 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 20.67 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 20.67 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.86 } ] } ] }, { "description": "CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CCMCC", "code_information": [ { "code": "262", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4707.0, "minimum": 4707.65, "maximum": 19214.86, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19214.86 } ] } ] }, { "description": "HC MRI, FACE, NECK W/CONTRAST", "code_information": [ { "code": "70542", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2434.38, "discounted_cash": 705.0, "minimum": 705.9702, "maximum": 2207.9827, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2118.32 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1694.64 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2118.32 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2118.32 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1694.67 } ] } ] }, { "description": "PANCREAS, LIVER AND SHUNT PROCEDURES WITH CC", "code_information": [ { "code": "406", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10536.0, "minimum": 10536.18, "maximum": 34190.4, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34190.4 } ] } ] }, { "description": "HC (SUP SHELL A4426) OST PCH DRAIN 2 PIECE SYSTEM", "code_information": [ { "code": "A4426", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 3.89, "maximum": 3.89, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3.89, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC TISSUE CULTURE, SKIN/SOLID TISS BIOPSY", "code_information": [ { "code": "88233", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1158.13, "discounted_cash": 335.0, "minimum": 140.73, "maximum": 1158.13, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 725.52 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 889.01 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 711.21 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 889.01 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 889.01 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1158.13 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 140.73, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CCMCC", "code_information": [ { "code": "745", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4483.0, "minimum": 4483.48, "maximum": 13409.96, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13409.96 } ] } ] }, { "description": "HC TESTICULAR IMAGING & FLOW", "code_information": [ { "code": "78761", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 746.25, "discounted_cash": 216.0, "minimum": 216.4125, "maximum": 746.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 668.14 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 746.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 654.96 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 746.25 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 746.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 746.25 } ] } ] }, { "description": "PSYCHOSES", "code_information": [ { "code": "885", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14571.0, "minimum": 14571.31, "maximum": 16466.85, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16466.85 } ] } ] }, { "description": "KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CCMCC", "code_information": [ { "code": "658", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3586.0, "minimum": 3586.78, "maximum": 18294.14, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18294.14 } ] } ] }, { "description": "HC (SUP SHELL A6199) ALGINATE DRSG WOUND FILLER", "code_information": [ { "code": "A6199", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 7.52, "maximum": 7.52, "payers_information": [ { "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" } ] } ] }, { "description": "HC SENSORY INTEGRATION EA 15 MIN", "code_information": [ { "code": "97533", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 104.69, "discounted_cash": 30.0, "minimum": 30.3601, "maximum": 95.0, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 57.11, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6251) ABSORPT DRG <=16 SQ IN W/O B", "code_information": [ { "code": "A6251", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2.84, "maximum": 2.84, "payers_information": [ { "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" } ] } ] }, { "description": "HC (SUP SHELL A4316) CATH W/DRAINAGE 3-WAY", "code_information": [ { "code": "A4316", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 40.47, "maximum": 40.47, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 40.47, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC ANGIO INTERN MAMMARY", "code_information": [ { "code": "75756", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3134.38, "discounted_cash": 908.0, "minimum": 908.9702, "maximum": 2842.8827, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 945.33 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1158.36 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 926.68 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1158.36 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1158.36 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 941.82 } ] } ] }, { "description": "HC ARC RBC PRETREATMENT/ENZYM", "code_information": [ { "code": "86971", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 37.5, "discounted_cash": 10.0, "minimum": 10.875, "maximum": 37.5, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.5 } ] } ] }, { "description": "TRANSURETHRAL PROCEDURES WITH CC", "code_information": [ { "code": "669", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8294.0, "minimum": 8294.44, "maximum": 18296.5, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18296.5 } ] } ] }, { "description": "Omalizumab Subcutaneous Soln Prefilled Syringe 75 MG/0.5ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "50242021403", "type": "NDC" }, { "code": "J2357", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 126.378, "maximum": 533.97, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 18206.35, "10th_percentile": 17413.05, "90th_percentile": 18206.35, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 533.97 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 188.48 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 150.78 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 188.48 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 188.48 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 126.38 } ] } ] }, { "description": "HC ASPERGILLUS AG EIA", "code_information": [ { "code": "87305", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 525.63, "discounted_cash": 152.0, "minimum": 11.98, "maximum": 476.7464, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 94.58 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 115.89 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 92.71 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 115.89 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 115.89 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 111.06 }, { "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" } ] } ] }, { "description": "SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CCMCC", "code_information": [ { "code": "575", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8966.0, "minimum": 8966.96, "maximum": 21184.8, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21184.8 } ] } ] }, { "description": "HC ASSAY OF HEMOSIDERIN, QUAL", "code_information": [ { "code": "83070", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 101.25, "discounted_cash": 29.0, "minimum": 4.75, "maximum": 91.8337, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 48.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 38.4 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 48.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 48.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.03 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITHOUT CCMCC", "code_information": [ { "code": "700", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5156.0, "minimum": 5156.0, "maximum": 8133.22, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8133.22 } ] } ] }, { "description": "HC CT ANGIO,LOWER EXTREM,COMBO,IMAGE PRC", "code_information": [ { "code": "73706", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2101.25, "discounted_cash": 609.0, "minimum": 609.3625, "maximum": 2058.4575, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1742.92 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1394.33 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1742.92 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1742.92 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2058.46 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1585.75, "10th_percentile": 1585.75, "90th_percentile": 1585.75, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 1267.49, "10th_percentile": 1267.49, "90th_percentile": 1267.49, "count": "1 through 10" } ] } ] }, { "description": "HC NM GATED HEART, PLANAR SINGLE", "code_information": [ { "code": "78472", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1543.13, "discounted_cash": 447.0, "minimum": 447.5077, "maximum": 1399.6189, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 843.2 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1033.21 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 826.56 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1033.21 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1033.21 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1398.62 } ] } ] }, { "description": "HC CT ANGIO, PELVIS, COMBO, INCL IMAGE PROC", "code_information": [ { "code": "72191", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2282.19, "discounted_cash": 661.0, "minimum": 650.0, "maximum": 2069.9463, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1744.7 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1395.75 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1744.7 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1744.7 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1934.37 } ] } ] }, { "description": "Albumin, Human Inj 25%", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "00944049303", "type": "NDC" }, { "code": "P9047", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 199.49, "maximum": 785.47, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 785.47 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 249.36 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 199.49 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 249.36 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 249.36 } ] } ] }, { "description": "HC (SUP SHELL Q4161) BIO-CONNEKT PER SQUARE CM", "code_information": [ { "code": "Q4161", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 5839.029, "maximum": 8718.65, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8718.65 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6974.84 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 8718.65 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 8718.65 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5839.03 } ] } ] }, { "description": "HC MAMMOGRAPHY; UNILATERAL", "code_information": [ { "code": "77065", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 501.88, "discounted_cash": 145.0, "minimum": 79.18, "maximum": 501.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 265.82, "10th_percentile": 265.82, "90th_percentile": 285.12, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 133.65, "10th_percentile": 133.65, "90th_percentile": 133.65, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 384.71 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 471.4 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 128.75, "10th_percentile": 128.75, "90th_percentile": 128.75, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 377.12 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 471.4 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 471.4 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 291.8, "10th_percentile": 291.8, "90th_percentile": 297.41, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 501.88 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 126.23, "10th_percentile": 4.14, "90th_percentile": 275.52, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 79.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 81.89, "10th_percentile": 81.19, "90th_percentile": 81.89, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 118.8, "10th_percentile": 118.8, "90th_percentile": 118.8, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 118.8, "10th_percentile": 118.8, "90th_percentile": 118.8, "count": "1 through 10" } ] } ] }, { "description": "HC IV INFU, HYDRATION, 31-60 MIN", "code_information": [ { "code": "96360", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 247.5, "discounted_cash": 71.0, "minimum": 71.775, "maximum": 224.4825, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 141.77, "10th_percentile": 141.77, "90th_percentile": 141.77, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 255.2, "10th_percentile": 255.2, "90th_percentile": 260.1, "count": "21" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 138.2, "10th_percentile": 138.2, "90th_percentile": 138.2, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 398.5, "10th_percentile": 269.03, "90th_percentile": 398.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 398.5, "10th_percentile": 398.5, "90th_percentile": 398.5, "count": "11" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 127.52, "10th_percentile": 127.52, "90th_percentile": 127.52, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 127.52, "10th_percentile": 127.52, "90th_percentile": 135.49, "count": "1 through 10" } ] } ] }, { "description": "HC CHEMOTHER, IV INFUSE, EACH SEQU INFUS", "code_information": [ { "code": "96417", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 452.81, "discounted_cash": 131.0, "minimum": 131.3149, "maximum": 410.6987, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 231.98, "10th_percentile": 231.98, "90th_percentile": 675.54, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 362.25, "10th_percentile": 362.25, "90th_percentile": 362.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 345.0, "10th_percentile": 345.0, "90th_percentile": 690.0, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 115.92, "10th_percentile": 115.92, "90th_percentile": 115.92, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 110.4, "10th_percentile": 110.4, "90th_percentile": 127.65, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 234.6, "10th_percentile": 234.6, "90th_percentile": 234.6, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 115.92, "10th_percentile": 115.92, "90th_percentile": 117.3, "count": "1 through 10" } ] } ] }, { "description": "CESAREAN SECTION WITH STERILIZATION WITHOUT CCMCC", "code_information": [ { "code": "785", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5828.0, "minimum": 5828.52, "maximum": 11291.49, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11291.49 } ] } ] }, { "description": "HC ASSAY OF URIC ACID, BLOOD", "code_information": [ { "code": "84550", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 80.63, "discounted_cash": 23.0, "minimum": 4.52, "maximum": 73.1314, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 55.67, "10th_percentile": 55.67, "90th_percentile": 60.26, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 27.99, "10th_percentile": 27.99, "90th_percentile": 27.99, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 37.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 45.65 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 26.97, "10th_percentile": 26.97, "90th_percentile": 26.97, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 36.52 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 45.65 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 45.65 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 49.53, "10th_percentile": 49.53, "90th_percentile": 49.53, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 61.11, "10th_percentile": 61.11, "90th_percentile": 62.29, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.9 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 77.75, "10th_percentile": 53.43, "90th_percentile": 77.75, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 77.75, "10th_percentile": 77.75, "90th_percentile": 77.75, "count": "15" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 24.88, "10th_percentile": 24.88, "90th_percentile": 26.44, "count": "26" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 70.52, "10th_percentile": 70.52, "90th_percentile": 70.52, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 24.88, "10th_percentile": 24.88, "90th_percentile": 28.77, "count": "16" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 24.88, "10th_percentile": 24.88, "90th_percentile": 24.88, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 24.88, "10th_percentile": 24.88, "90th_percentile": 26.44, "count": "1 through 10" } ] } ] }, { "description": "HC ANTINUCLEAR ANTIBODIES", "code_information": [ { "code": "86038", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 190.94, "discounted_cash": 55.0, "minimum": 12.09, "maximum": 173.1826, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 103.1, "10th_percentile": 103.1, "90th_percentile": 111.6, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 99.78 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 122.26 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 49.94, "10th_percentile": 49.94, "90th_percentile": 52.98, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 97.81 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 122.26 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 122.26 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 91.73, "10th_percentile": 91.73, "90th_percentile": 91.73, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 115.36, "10th_percentile": 115.36, "90th_percentile": 120.06, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 112.08 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 152.75, "10th_percentile": 144.0, "90th_percentile": 152.75, "count": "35" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 48.88, "10th_percentile": 46.08, "90th_percentile": 48.88, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 138.54, "10th_percentile": 138.54, "90th_percentile": 138.54, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 48.88, "10th_percentile": 46.08, "90th_percentile": 48.88, "count": "13" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 48.88, "10th_percentile": 48.88, "90th_percentile": 48.96, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL L3900) HINGE EXTENSION/FLEX WRIST/F", "code_information": [ { "code": "L3900", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1462.94, "maximum": 1462.94, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1462.94, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC ANTITHROMBIN III TEST,ACTIV", "code_information": [ { "code": "85300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 356.56, "discounted_cash": 103.0, "minimum": 11.85, "maximum": 323.3999, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 97.8 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 119.84 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 95.87 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 119.84 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 119.84 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 109.86 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 91.28, "10th_percentile": 91.28, "90th_percentile": 91.28, "count": "1 through 10" } ] } ] }, { "description": "Gentamicin Sulfate Inj 40 MG/ML", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "63323001001", "type": "NDC" }, { "code": "J1580", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 7.7805, "maximum": 19.97, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 19.97 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.6 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 11.6 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 11.6 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.78 } ] } ] }, { "description": "HC IA INFECTIOUS AGT ANTIBODY SARS-COV-2 COVID-19", "code_information": [ { "code": "86328", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 302.19, "discounted_cash": 87.0, "minimum": 45.28, "maximum": 302.19, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 302.19 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 45.28, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Dextrose 5% in Lactated Ringers", "drug_information": { "unit": 1000.0, "type": "ML" }, "code_information": [ { "code": "00338012504", "type": "NDC" }, { "code": "J7121", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 25.641, "maximum": 74.53, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 74.53 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 38.24 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 30.59 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 38.24 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 38.24 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.64 } ] } ] }, { "description": "HC (SUP SHELL A4414) OST SKNBAR W/O CONV<=4 SQ IN", "code_information": [ { "code": "A4414", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 7.01, "maximum": 20.06, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.06 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 16.05 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 20.06 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 20.06 }, { "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" } ] } ] }, { "description": "HC SPECIAL STAINS,GROUP II", "code_information": [ { "code": "88313", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 225.31, "discounted_cash": 65.0, "minimum": 65.3399, "maximum": 225.31, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 225.31 } ] } ] }, { "description": "CESAREAN SECTION WITH STERILIZATION WITH CC", "code_information": [ { "code": "784", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6949.0, "minimum": 6949.39, "maximum": 12497.5, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12497.5 } ] } ] }, { "description": "Dextrose 5% w/ Sodium Chloride 0.45%", "drug_information": { "unit": 1000.0, "type": "ML" }, "code_information": [ { "code": "00338008504", "type": "NDC" }, { "code": "J7060", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 5.733, "maximum": 33.51, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 33.51 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.64 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6.92 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 8.64 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 8.64 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.73 } ] } ] }, { "description": "MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC", "code_information": [ { "code": "827", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8966.0, "minimum": 8966.96, "maximum": 27246.69, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27246.69 } ] } ] }, { "description": "Diphenhydramine HCl Inj 50 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "63323066400", "type": "NDC" }, { "code": "J1200", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2.079, "maximum": 8.66, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 12.77, "10th_percentile": 12.77, "90th_percentile": 13.54, "count": "33" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.66 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.1 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2.48 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 3.1 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 3.1 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2.08 } ] } ] }, { "description": "Linezolid IV Soln 600 MG/300ML (2 MG/ML)", "drug_information": { "unit": 300.0, "type": "ML" }, "code_information": [ { "code": "55150024251", "type": "NDC" }, { "code": "J2020", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 10.9305, "maximum": 175.2, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 175.2 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.3 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13.04 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 16.3 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 16.3 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.93 } ] } ] }, { "description": "COMPLICATIONS OF TREATMENT WITHOUT CCMCC", "code_information": [ { "code": "921", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4707.0, "minimum": 4707.65, "maximum": 8115.53, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8115.53 } ] } ] }, { "description": "Cefazolin Sodium For Inj 1 GM", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "44567070725", "type": "NDC" }, { "code": "J0690", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2.6145, "maximum": 11.46, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.46 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.9 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3.12 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 3.9 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 3.9 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2.61 } ] } ] }, { "description": "HC REAGENT STRIP/BLOOD GLUCOSE", "code_information": [ { "code": "82948", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19.06, "discounted_cash": 5.0, "minimum": 5.04, "maximum": 19.06, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 19.06 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.06 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 19.06 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 19.06 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 19.06 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.06 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC", "code_information": [ { "code": "558", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6949.0, "minimum": 6949.39, "maximum": 10529.92, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10529.92 } ] } ] }, { "description": "HC CT ORBIT/SELLA/POST FOSSA/EAR W CONTR", "code_information": [ { "code": "70481", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2255.63, "discounted_cash": 654.0, "minimum": 650.0, "maximum": 2045.8564, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1524.84 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1219.86 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1524.84 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1524.84 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1119.44 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1804.5, "10th_percentile": 1804.5, "90th_percentile": 1804.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 577.44, "10th_percentile": 577.44, "90th_percentile": 577.44, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 577.44, "10th_percentile": 577.44, "90th_percentile": 577.44, "count": "1 through 10" } ] } ] }, { "description": "CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC", "code_information": [ { "code": "287", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4707.0, "minimum": 4707.65, "maximum": 12615.39, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12615.39 } ] } ] }, { "description": "HC X-RAY FACIAL BONES 3+ VW", "code_information": [ { "code": "70150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 570.31, "discounted_cash": 165.0, "minimum": 115.82, "maximum": 517.2712, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 118.15 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 144.78 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 115.82 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 144.78 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 144.78 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 296.05 } ] } ] }, { "description": "CERVICAL SPINAL FUSION WITH CC", "code_information": [ { "code": "472", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5604.0, "minimum": 5604.35, "maximum": 34731.51, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34731.51 } ] } ] }, { "description": "HYPERTENSION WITHOUT MCC", "code_information": [ { "code": "305", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4707.0, "minimum": 4707.65, "maximum": 8901.86, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8901.86 } ] } ] }, { "description": "Cosyntropin For Inj 0.25 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00548590000", "type": "NDC" }, { "code": "J0834", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 105.21, "maximum": 487.24, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 487.24 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 156.91 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 125.52 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 156.91 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 156.91 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 105.21 } ] } ] }, { "description": "HC (SUP SHELL A7526) TRACHEOSTOMY TUBE COLLAR - A7526 - 27100031", "code_information": [ { "code": "A7526", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 4.83, "maximum": 4.83, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.83, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF PRIMIDONE", "code_information": [ { "code": "80188", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 170.63, "discounted_cash": 49.0, "minimum": 16.59, "maximum": 167.84, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 136.97 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 167.84 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 134.27 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 167.84 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 167.84 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 153.8 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 41.2, "10th_percentile": 41.2, "90th_percentile": 43.68, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL E0971) WHEELCHAIR ANTI-TIPPING DEVI", "code_information": [ { "code": "E0971", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 36.92, "maximum": 36.92, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 36.92, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC INFLUENZA VIRUS", "code_information": [ { "code": "86710", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 297.5, "discounted_cash": 86.0, "minimum": 13.55, "maximum": 269.8325, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 86.15 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 105.57 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 84.45 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 105.57 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 105.57 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 125.62 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.55, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC US GUID,COMP REPAIR,PSEUDO-ANEUR/AV FIST", "code_information": [ { "code": "76936", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 694.38, "discounted_cash": 201.0, "minimum": 201.3702, "maximum": 694.38, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 382.2 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 468.33 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 374.66 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 468.33 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 468.33 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 694.38 } ] } ] }, { "description": "HC RAD GUIDED,PERCUT DRAINAGE,W/CATH PLACE", "code_information": [ { "code": "75989", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2751.56, "discounted_cash": 797.0, "minimum": 330.33, "maximum": 2495.6649, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 336.98 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 412.92 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 330.33 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 412.92 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 412.92 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 482.21 } ] } ] }, { "description": "INTERSTITIAL LUNG DISEASE WITH CC", "code_information": [ { "code": "197", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6501.0, "minimum": 6501.05, "maximum": 11188.92, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11188.92 } ] } ] }, { "description": "HC (SUP SHELL L3540) ORTHO SHOE ADD FULL SOLE", "code_information": [ { "code": "L3540", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 61.04, "maximum": 61.04, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 61.04, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL E0978) W/C ACC,SAF BELT PELV STRAP", "code_information": [ { "code": "E0978", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 29.68, "maximum": 29.68, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 29.68, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC OR TOTAL ANKLE REPLACEMENT", "code_information": [ { "code": "469", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7397.0, "minimum": 7397.74, "maximum": 35758.33, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 35758.33 } ] } ] }, { "description": "Insulin Glargine Inj 100 Unit/ML", "drug_information": { "unit": 3.0, "type": "ML" }, "code_information": [ { "code": "00088221905", "type": "NDC" }, { "code": "J1815", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 13.8, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.8 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.08 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.08 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.08 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "Bupivacaine HCl Preservative Free (PF) Inj 0.5%", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "70594011702", "type": "NDC" }, { "code": "J0665", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC C-REACTIVE PROTEIN,HIGH SENSITIVITY", "code_information": [ { "code": "86141", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 174.38, "discounted_cash": 50.0, "minimum": 12.95, "maximum": 158.1627, "payers_information": [ { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 109.65, "10th_percentile": 109.65, "90th_percentile": 109.65, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 120.05 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 139.5, "10th_percentile": 131.5, "90th_percentile": 139.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 44.64, "10th_percentile": 44.64, "90th_percentile": 44.64, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 44.64, "10th_percentile": 44.64, "90th_percentile": 44.64, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 44.64, "10th_percentile": 44.64, "90th_percentile": 44.64, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 101.91, "10th_percentile": 101.91, "90th_percentile": 101.91, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 106.9 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 130.99 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 104.79 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 130.99 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 130.99 } ] } ] }, { "description": "OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "716", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3586.0, "minimum": 3586.78, "maximum": 17341.59, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17341.59 } ] } ] }, { "description": "MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES", "code_information": [ { "code": "483", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4483.0, "minimum": 4483.48, "maximum": 32677.87, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 32677.87 } ] } ] }, { "description": "PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC", "code_information": [ { "code": "542", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11208.0, "minimum": 11208.7, "maximum": 20825.23, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20825.23 } ] } ] }, { "description": "HC (SUP SHELL C2638) BRACHYTX, STRANDED, I-125", "code_information": [ { "code": "C2638", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 116.676, "maximum": 116.676, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 116.68 } ] } ] }, { "description": "HC MRA ABDOMEN ANGIO - 74185 - 61800003", "code_information": [ { "code": "74185", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3124.69, "discounted_cash": 906.0, "minimum": 900.0, "maximum": 2834.0938, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2118.32 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1694.64 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2118.32 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2118.32 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2224.82 } ] } ] }, { "description": "SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC", "code_information": [ { "code": "622", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19278.0, "minimum": 19278.96, "maximum": 41959.34, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 41959.34 } ] } ] }, { "description": "SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT", "code_information": [ { "code": "008", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19054.0, "minimum": 19054.79, "maximum": 66072.52, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 66072.52 } ] } ] }, { "description": "POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC", "code_information": [ { "code": "857", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12105.0, "minimum": 12105.4, "maximum": 25246.1, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25246.1 } ] } ] }, { "description": "HC (SUP SHELL A5112) URINARY LEG BAG", "code_information": [ { "code": "A5112", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 42.67, "maximum": 42.67, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 42.67, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC RADEX SPINE CERVICAL 6 OR MORE VIEWS", "code_information": [ { "code": "72052", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 855.94, "discounted_cash": 248.0, "minimum": 183.03, "maximum": 776.3376, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 186.71 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 228.79 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 183.03 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 228.79 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 228.79 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 408.86 } ] } ] }, { "description": "OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "425", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5828.0, "minimum": 5828.52, "maximum": 17687.01, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17687.01 } ] } ] }, { "description": "HC BACTERIA IDENTIFICATION, AEROBIC ISOLATE", "code_information": [ { "code": "87077", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 101.88, "discounted_cash": 29.0, "minimum": 8.08, "maximum": 92.4052, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 55.13, "10th_percentile": 55.13, "90th_percentile": 59.68, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 29.34, "10th_percentile": 29.34, "90th_percentile": 29.34, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 43.13 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 52.85 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 28.26, "10th_percentile": 26.7, "90th_percentile": 56.53, "count": "18" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 42.28 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 52.85 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 52.85 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 51.92, "10th_percentile": 51.92, "90th_percentile": 51.92, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 61.68, "10th_percentile": 61.68, "90th_percentile": 64.06, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 74.91 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 15.2, "10th_percentile": 8.08, "90th_percentile": 81.5, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 18.94, "10th_percentile": 18.94, "90th_percentile": 18.94, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 81.5, "10th_percentile": 77.0, "90th_percentile": 81.5, "count": "65" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 26.08, "10th_percentile": 8.08, "90th_percentile": 52.16, "count": "65" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 73.92, "10th_percentile": 70.53, "90th_percentile": 221.76, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 26.08, "10th_percentile": 24.64, "90th_percentile": 52.16, "count": "36" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 52.16, "10th_percentile": 26.08, "90th_percentile": 78.24, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 26.08, "10th_percentile": 24.64, "90th_percentile": 49.28, "count": "17" } ] } ] }, { "description": "HC ARTHROGRAM OF HIP", "code_information": [ { "code": "73525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 512.19, "discounted_cash": 148.0, "minimum": 148.5351, "maximum": 512.19, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 274.24 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 336.04 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 268.83 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 336.04 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 336.04 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 512.19 } ] } ] }, { "description": "HC TB TEST, CELL MDIATD ANTGEN RESPS GAMMA INTFRON", "code_information": [ { "code": "86480", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 399.06, "discounted_cash": 115.0, "minimum": 61.98, "maximum": 399.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 215.7, "10th_percentile": 215.7, "90th_percentile": 233.47, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 108.45, "10th_percentile": 108.45, "90th_percentile": 114.93, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 399.06 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 399.06 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 110.72, "10th_percentile": 110.72, "90th_percentile": 110.72, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 399.06 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 399.06 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 399.06 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 399.06 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 80.4, "10th_percentile": 80.4, "90th_percentile": 80.4, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 61.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 319.25, "10th_percentile": 301.25, "90th_percentile": 319.25, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 102.16, "10th_percentile": 102.16, "90th_percentile": 102.43, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 275.95, "10th_percentile": 275.95, "90th_percentile": 289.56, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 102.16, "10th_percentile": 102.16, "90th_percentile": 111.46, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 102.16, "10th_percentile": 102.16, "90th_percentile": 102.16, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 102.16, "10th_percentile": 102.16, "90th_percentile": 102.16, "count": "1 through 10" } ] } ] }, { "description": "HC XRAY SPINE, COMPLETE, =>6 VW", "code_information": [ { "code": "72084", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 677.19, "discounted_cash": 196.0, "minimum": 196.3851, "maximum": 668.3055, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 668.31 } ] } ] }, { "description": "LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "825", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4931.0, "minimum": 4931.83, "maximum": 15908.05, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15908.05 } ] } ] }, { "description": "HC FERN TEST - Q0114 - 30600080", "code_information": [ { "code": "Q0114", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 88.13, "minimum": 9.74, "maximum": 88.13, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 72.32 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 57.85 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 72.32 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 72.32 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 88.13 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 9.74, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC MR SAFETY DETERMINATION PHYSICIAN/OTHER QHP", "code_information": [ { "code": "76016", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 330.31, "discounted_cash": 95.0, "minimum": 95.7899, "maximum": 330.31, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 330.31 } ] } ] }, { "description": "HC CT SCAN HEAD CONTRAST", "code_information": [ { "code": "70460", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2340.31, "discounted_cash": 678.0, "minimum": 650.0, "maximum": 2122.6612, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1113.65 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 890.92 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1113.65 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1113.65 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 837.46 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1766.25, "10th_percentile": 1766.25, "90th_percentile": 1766.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 599.12, "10th_percentile": 599.12, "90th_percentile": 599.12, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 565.2, "10th_percentile": 565.2, "90th_percentile": 565.2, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 599.12, "10th_percentile": 599.12, "90th_percentile": 599.12, "count": "1 through 10" } ] } ] }, { "description": "HC MR-STAPH DNA AMP PROBE", "code_information": [ { "code": "87641", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 265.0, "discounted_cash": 76.0, "minimum": 35.09, "maximum": 265.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 143.2, "10th_percentile": 143.2, "90th_percentile": 143.2, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 214.99 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 263.43 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 210.75 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 263.43 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 263.43 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 265.0 }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 212.0, "10th_percentile": 200.0, "90th_percentile": 212.0, "count": "20" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 183.2, "10th_percentile": 183.2, "90th_percentile": 183.2, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL Q4148) NEOX NEOX RT OR CLARIX CORD", "code_information": [ { "code": "Q4148", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 404.5545, "maximum": 3292.05, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3292.05 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 603.34 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 482.67 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 603.34 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 603.34 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 404.55 } ] } ] }, { "description": "GASTROINTESTINAL HEMORRHAGE WITH CC", "code_information": [ { "code": "378", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6501.0, "minimum": 6501.05, "maximum": 11561.45, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11561.45 } ] } ] }, { "description": "CORONARY INTRAVASCULAR LITHOTRIPSY WITHOUT INTRALUMINAL DEVICE", "code_information": [ { "code": "325", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6276.0, "minimum": 6276.87, "maximum": 37847.34, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 37847.34 } ] } ] }, { "description": "HC CHLAMYDIA, IGM, ANTIBODY", "code_information": [ { "code": "86632", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 102.5, "discounted_cash": 29.0, "minimum": 12.68, "maximum": 102.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 102.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 102.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 102.5 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 102.5 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 102.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 102.5 }, { "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" } ] } ] }, { "description": "MALIGNANT BREAST DISORDERS WITH MCC", "code_information": [ { "code": "597", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10536.0, "minimum": 10536.18, "maximum": 19653.41, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19653.41 } ] } ] }, { "description": "HC ASSAY OF CALCITONIN", "code_information": [ { "code": "82308", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 943.44, "discounted_cash": 273.0, "minimum": 26.79, "maximum": 855.7001, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 221.04 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 270.85 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 216.68 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 270.85 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 270.85 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 248.36 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Cefoxitin Sodium For IV Soln 2 GM", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "25021011020", "type": "NDC" }, { "code": "J0694", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 15.7815, "maximum": 56.28, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 56.28 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.54 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 18.83 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 23.54 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 23.54 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.78 } ] } ] }, { "description": "HC (SUP SHELL A4399) OSTOMY IRRIG CONE/CATH W BRS", "code_information": [ { "code": "A4399", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 17.48, "maximum": 88.69, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 88.69 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 70.95 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 88.69 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 88.69 }, { "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" } ] } ] }, { "description": "HC MRI BREAST WITHOUT&WITH CONTRAST W/CAD BILATERAL - C8908 - 61077049", "code_information": [ { "code": "C8908", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1173.75, "minimum": 340.3875, "maximum": 1064.5912, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 } ] } ] }, { "description": "HC X-RAY LUMBAR SPINE 4 VW", "code_information": [ { "code": "72110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 879.38, "discounted_cash": 255.0, "minimum": 150.16, "maximum": 797.5977, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 238.95, "10th_percentile": 238.95, "90th_percentile": 238.95, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 153.18 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 187.7 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 150.16 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 187.7 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 187.7 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 335.59 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 663.75, "10th_percentile": 663.75, "90th_percentile": 703.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 225.12, "10th_percentile": 212.4, "90th_percentile": 225.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 225.12, "10th_percentile": 225.12, "90th_percentile": 225.12, "count": "1 through 10" } ] } ] }, { "description": "HC DEVELOPMENTAL SCREEN - G0451 - 44000053", "code_information": [ { "code": "G0451", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 449.06, "minimum": 95.0, "maximum": 407.2974, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "HC X-RAY ABDOMEN,COMP ACUTE SERIES", "code_information": [ { "code": "74022", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 963.75, "discounted_cash": 279.0, "minimum": 125.85, "maximum": 874.1213, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 261.81, "10th_percentile": 261.81, "90th_percentile": 261.81, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 128.39 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 157.32 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 252.22, "10th_percentile": 252.22, "90th_percentile": 252.22, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 125.85 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 157.32 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 157.32 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 296.05 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 727.25, "10th_percentile": 727.25, "90th_percentile": 771.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 232.72, "10th_percentile": 232.72, "90th_percentile": 232.72, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 232.72, "10th_percentile": 232.72, "90th_percentile": 232.72, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL A4327) FEM URINARY COLLECT DEV CUP", "code_information": [ { "code": "A4327", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 60.23, "maximum": 60.23, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 60.23, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC INTRAOPERATIVE CYTO PATH CONSULT, INITIAL SITE", "code_information": [ { "code": "88333", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 223.13, "discounted_cash": 64.0, "minimum": 64.7077, "maximum": 223.13, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 223.13 } ] } ] }, { "description": "HC (SUP SHELL C2645) BRACHYTX PLANAR, P-103", "code_information": [ { "code": "C2645", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 14.7735, "maximum": 14.7735, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.77 } ] } ] }, { "description": "HC (SUP SHELL A6211) FOAM DRG > 48 SQ IN W/O BRDR", "code_information": [ { "code": "A6211", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 41.86, "maximum": 41.86, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 41.86, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "328", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4483.0, "minimum": 4483.48, "maximum": 18889.48, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18889.48 } ] } ] }, { "description": "HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CCMCC", "code_information": [ { "code": "482", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6949.0, "minimum": 6949.39, "maximum": 19227.83, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19227.83 } ] } ] }, { "description": "Acetaminophen IV Soln 10 MG/ML", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "00143938601", "type": "NDC" }, { "code": "J0131", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 6.02, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.02 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC OT EXERCISE OTA COMPLEX EA 15", "code_information": [ { "code": "97110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 147.5, "discounted_cash": 42.0, "minimum": 27.84, "maximum": 133.7825, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 118.0, "10th_percentile": 118.0, "90th_percentile": 118.0, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 27.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 37.76, "10th_percentile": 37.76, "90th_percentile": 37.76, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 37.76, "10th_percentile": 11.33, "90th_percentile": 113.28, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 127.44, "10th_percentile": 127.44, "90th_percentile": 127.44, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL Q4154) BIOVANCE 1 SQUARE CM", "code_information": [ { "code": "Q4154", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 421.029, "maximum": 4388.97, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4388.97 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 627.91 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 502.32 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 627.91 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 627.91 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 421.03 } ] } ] }, { "description": "HC DEHYDROEPIANDROSTERONE-SULFATE", "code_information": [ { "code": "82627", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 375.94, "discounted_cash": 109.0, "minimum": 22.23, "maximum": 340.9776, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 183.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 224.85 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 179.88 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 224.85 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 224.85 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 206.08 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 22.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 300.75, "10th_percentile": 300.75, "90th_percentile": 300.75, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 272.78, "10th_percentile": 272.78, "90th_percentile": 272.78, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 96.24, "10th_percentile": 96.24, "90th_percentile": 96.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 96.24, "10th_percentile": 96.24, "90th_percentile": 96.24, "count": "1 through 10" } ] } ] }, { "description": "OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH CC", "code_information": [ { "code": "629", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13226.0, "minimum": 13226.27, "maximum": 25685.83, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25685.83 } ] } ] }, { "description": "HC REPR WND SMP BODY/SCALP/EXTR <2.5 CM", "code_information": [ { "code": "12001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 431.56, "discounted_cash": 125.0, "minimum": 125.1524, "maximum": 391.4249, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 254.78, "10th_percentile": 254.78, "90th_percentile": 254.78, "count": "1 through 10" } ] } ] }, { "description": "HC EVAL,SWALLOW FUNCTION,CINE/VIDEO RECORD, 30 MIN", "code_information": [ { "code": "92611", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 531.56, "discounted_cash": 154.0, "minimum": 87.2, "maximum": 482.1249, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 87.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC ONC PRST8 CA ALYS ALL PSA STRUCTURAL ISOFORMS", "code_information": [ { "code": "0359U", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1015.63, "minimum": 294.5327, "maximum": 1015.63, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1015.63 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 760.0, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC RADEX SPINE CERVICAL 2 OR 3 VIEWS", "code_information": [ { "code": "72040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 583.13, "discounted_cash": 169.0, "minimum": 100.12, "maximum": 528.8989, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 315.04, "10th_percentile": 315.04, "90th_percentile": 315.04, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 102.13 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 125.15 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 100.12 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 125.15 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 125.15 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 245.3 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 149.6, "10th_percentile": 149.6, "90th_percentile": 149.6, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 466.5, "10th_percentile": 440.0, "90th_percentile": 466.5, "count": "12" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 149.28, "10th_percentile": 140.8, "90th_percentile": 149.28, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 149.28, "10th_percentile": 149.28, "90th_percentile": 149.28, "count": "1 through 10" } ] } ] }, { "description": "OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH CC", "code_information": [ { "code": "868", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7621.0, "minimum": 7621.92, "maximum": 19272.537, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 7621.92, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 6167.61, "10th_percentile": 6167.61, "90th_percentile": 26379.21, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12155.62 } ] } ] }, { "description": "HC (SUP SHELL L8612) AQUEOUS SHUNT", "code_information": [ { "code": "L8612", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 878.38, "maximum": 878.38, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 878.38, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC VENOGRAM EPIDURAL", "code_information": [ { "code": "75872", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1760.31, "discounted_cash": 510.0, "minimum": 510.4899, "maximum": 1596.6012, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 939.51 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1151.22 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 920.97 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1151.22 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1151.22 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 634.43 } ] } ] }, { "description": "HC GROUP MNT 2 OR MORE 30 MINS", "code_information": [ { "code": "G0271", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 30.31, "minimum": 8.7899, "maximum": 27.4912, "payers_information": [ { "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" } ] } ] }, { "description": "HC ASSAY OF DIGOXIN", "code_information": [ { "code": "80162", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 178.44, "discounted_cash": 51.0, "minimum": 13.28, "maximum": 161.8451, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 109.61 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 134.31 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 107.45 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 134.31 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 134.31 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 123.11 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 43.12, "10th_percentile": 43.12, "90th_percentile": 43.12, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 43.12, "10th_percentile": 43.12, "90th_percentile": 49.86, "count": "1 through 10" } ] } ] }, { "description": "PERIPHERAL VASCULAR DISORDERS WITH MCC", "code_information": [ { "code": "299", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8742.0, "minimum": 8742.79, "maximum": 19247.87, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19247.87 } ] } ] }, { "description": "LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH MCC", "code_information": [ { "code": "495", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16140.0, "minimum": 16140.53, "maximum": 42743.3, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 42743.3 } ] } ] }, { "description": "CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC", "code_information": [ { "code": "286", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12105.0, "minimum": 12105.4, "maximum": 26086.65, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26086.65 } ] } ] }, { "description": "HC (SUP SHELL L1932) AFO RIG ANT TIB PREFAB TCF/=", "code_information": [ { "code": "L1932", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1070.39, "maximum": 1070.39, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1070.39, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC EVALUATION OF SPEECH FLUENCY (STUTTER CLUTTER), 15 MIN", "code_information": [ { "code": "92521", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 535.31, "discounted_cash": 155.0, "minimum": 95.0, "maximum": 485.5262, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 128.49, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC SWALLOWING FCN,W/CINE &/OR VIDEO", "code_information": [ { "code": "74230", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1111.25, "discounted_cash": 322.0, "minimum": 243.1, "maximum": 1007.9037, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 247.99 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 303.88 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 243.1 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 303.88 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 303.88 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 843.13 } ] } ] }, { "description": "HC CT SCAN,THORACIC SPINE,W/O CONTRAST", "code_information": [ { "code": "72128", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2050.0, "discounted_cash": 594.0, "minimum": 594.5, "maximum": 1859.35, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 963.52 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 770.82 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 963.52 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 963.52 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 730.31 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1640.0, "10th_percentile": 1640.0, "90th_percentile": 1640.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 495.12, "10th_percentile": 495.12, "90th_percentile": 524.8, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 524.8, "10th_percentile": 524.8, "90th_percentile": 524.8, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 495.12, "10th_percentile": 495.12, "90th_percentile": 524.8, "count": "1 through 10" } ] } ] }, { "description": "Levonorgestrel IUD 21 MCG/DAY (Initial) (52 MG Total)", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "50419042301", "type": "NDC" }, { "code": "J7298", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 3902.6295, "maximum": 12868.11, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12868.11 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5820.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4656.15 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 5820.25 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 5820.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3902.63 } ] } ] }, { "description": "HC MRI SPINAL CANAL THORACIC W/CONTRAST", "code_information": [ { "code": "72147", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2563.13, "discounted_cash": 743.0, "minimum": 743.3077, "maximum": 2324.7589, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2118.32 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1694.64 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2118.32 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2118.32 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1669.33 } ] } ] }, { "description": "HC X-RAY WRIST 2 VW", "code_information": [ { "code": "73100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 434.38, "discounted_cash": 125.0, "minimum": 77.24, "maximum": 393.9827, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 78.79 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 96.55 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 77.24 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 96.55 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 96.55 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 219.97 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 347.5, "10th_percentile": 327.75, "90th_percentile": 347.5, "count": "1 through 10" } ] } ] }, { "description": "HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "422", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5156.0, "minimum": 5156.0, "maximum": 16498.68, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16498.68 } ] } ] }, { "description": "EXTRACRANIAL PROCEDURES WITH CC", "code_information": [ { "code": "038", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4259.0, "minimum": 4259.31, "maximum": 19128.8, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19128.8 } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC", "code_information": [ { "code": "190", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7397.0, "minimum": 7397.74, "maximum": 13378.5366, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "other", "standard_charge_dollar": 7730.65, "standard_charge_algorithm": "2342.62 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 5755.14, "10th_percentile": 5755.14, "90th_percentile": 5755.14, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 7397.74, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 2143.82, "10th_percentile": 2143.82, "90th_percentile": 2143.82, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13058.65 } ] } ] }, { "description": "HC CT SCAN OF PELVIS CONTRAST", "code_information": [ { "code": "72193", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2424.38, "discounted_cash": 703.0, "minimum": 650.0, "maximum": 2198.9127, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1315.68 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 634.56, "10th_percentile": 634.56, "90th_percentile": 634.56, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1052.54 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1315.68 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1315.68 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1528.31 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 535.64, "10th_percentile": 535.64, "90th_percentile": 1110.44, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1829.75, "10th_percentile": 1829.75, "90th_percentile": 1939.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 620.64, "10th_percentile": 620.64, "90th_percentile": 620.64, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 620.64, "10th_percentile": 620.64, "90th_percentile": 620.64, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 620.64, "10th_percentile": 620.64, "90th_percentile": 622.12, "count": "1 through 10" } ] } ] }, { "description": "SKIN DEBRIDEMENT WITH CC", "code_information": [ { "code": "571", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11208.0, "minimum": 11208.7, "maximum": 19917.48, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19917.48 } ] } ] }, { "description": "HC MRI, PELVIS, COMBO", "code_information": [ { "code": "72197", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4086.25, "discounted_cash": 1185.0, "minimum": 900.0, "maximum": 3706.2288, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2670.71 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2136.55 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2670.71 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2670.71 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2061.26 } ] } ] }, { "description": "HC DRUG SCRN QUANT OXCARBAZEPIN", "code_information": [ { "code": "80183", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 117.5, "discounted_cash": 34.0, "minimum": 13.25, "maximum": 117.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 102.26 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 117.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 100.25 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 117.5 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 117.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 117.5 }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 12.66, "10th_percentile": 12.66, "90th_percentile": 12.66, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 30.08, "10th_percentile": 30.08, "90th_percentile": 30.08, "count": "1 through 10" } ] } ] }, { "description": "RADIOTHERAPY", "code_information": [ { "code": "849", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15916.0, "minimum": 15916.35, "maximum": 31942.24, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 31942.24 } ] } ] }, { "description": "HC DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/CONTRAST", "code_information": [ { "code": "71260", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3165.31, "discounted_cash": 917.0, "minimum": 650.0, "maximum": 2870.9362, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 1710.52, "10th_percentile": 1710.52, "90th_percentile": 1710.52, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 860.04, "10th_percentile": 430.02, "90th_percentile": 911.61, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1381.79 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 878.19, "10th_percentile": 828.51, "90th_percentile": 878.19, "count": "24" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1105.43 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1381.79 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1381.79 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 1990.35, "10th_percentile": 1626.76, "90th_percentile": 1990.35, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 986.96 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 725.32, "10th_percentile": 679.48, "90th_percentile": 812.26, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 2532.25, "10th_percentile": 2389.0, "90th_percentile": 2532.25, "count": "41" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 810.32, "10th_percentile": 764.48, "90th_percentile": 812.26, "count": "72" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 2296.75, "10th_percentile": 2188.32, "90th_percentile": 2296.75, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 810.32, "10th_percentile": 764.48, "90th_percentile": 883.93, "count": "44" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 810.32, "10th_percentile": 764.48, "90th_percentile": 812.26, "count": "27" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 810.32, "10th_percentile": 810.32, "90th_percentile": 812.26, "count": "22" } ] } ] }, { "description": "HC ASSAY OF QUINIDINE", "code_information": [ { "code": "80194", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 143.75, "discounted_cash": 41.0, "minimum": 14.6, "maximum": 143.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 120.47 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 143.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 118.09 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 143.75 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 143.75 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 135.35 }, { "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" } ] } ] }, { "description": "HC (SUP SHELL A4608) TRANSTRACHEAL OXYGEN CATH", "code_information": [ { "code": "A4608", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 71.44, "maximum": 71.44, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 71.44, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC CREATINE, MB FRACTION", "code_information": [ { "code": "82553", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 262.81, "discounted_cash": 76.0, "minimum": 11.55, "maximum": 238.3687, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 63.99 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 78.41 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 62.73 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 78.41 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 78.41 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 107.07 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 67.28, "10th_percentile": 67.28, "90th_percentile": 67.28, "count": "1 through 10" } ] } ] }, { "description": "HC RUBELLA", "code_information": [ { "code": "86762", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 114.06, "discounted_cash": 33.0, "minimum": 14.39, "maximum": 114.06, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 114.06 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 114.06 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 114.06 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 114.06 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 114.06 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 114.06 }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 86.0, "10th_percentile": 86.0, "90th_percentile": 91.25, "count": "11" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 29.2, "10th_percentile": 29.2, "90th_percentile": 29.2, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 78.78, "10th_percentile": 78.78, "90th_percentile": 82.76, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 29.2, "10th_percentile": 29.2, "90th_percentile": 29.2, "count": "1 through 10" } ] } ] }, { "description": "HC TRIIODOTHYRONINE T3 REVERSE", "code_information": [ { "code": "84482", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 215.31, "discounted_cash": 62.0, "minimum": 15.76, "maximum": 195.2862, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 125.67 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 153.99 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 123.19 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 153.99 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 153.99 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 146.1 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 15.76, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "REVISION OF HIP OR KNEE REPLACEMENT WITH MCC", "code_information": [ { "code": "466", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15916.0, "minimum": 15916.35, "maximum": 61366.36, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 61366.36 } ] } ] }, { "description": "HC IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ", "code_information": [ { "code": "87636", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 568.13, "discounted_cash": 164.0, "minimum": 142.63, "maximum": 568.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 306.99, "10th_percentile": 306.99, "90th_percentile": 332.28, "count": "13" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 154.35, "10th_percentile": 154.35, "90th_percentile": 163.62, "count": "22" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 428.75, "10th_percentile": 428.75, "90th_percentile": 454.5, "count": "19" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 148.7, "10th_percentile": 148.7, "90th_percentile": 157.62, "count": "22" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 171.16, "10th_percentile": 142.63, "90th_percentile": 289.13, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 357.24, "10th_percentile": 343.47, "90th_percentile": 357.24, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 568.13 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 145.78, "10th_percentile": 145.44, "90th_percentile": 428.75, "count": "19" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 142.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 99.84, "10th_percentile": 99.84, "90th_percentile": 99.84, "count": "552" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 145.44, "10th_percentile": 137.2, "90th_percentile": 145.78, "count": "53" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 392.74, "10th_percentile": 342.7, "90th_percentile": 412.23, "count": "30" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 145.44, "10th_percentile": 137.2, "90th_percentile": 145.44, "count": "57" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 145.44, "10th_percentile": 137.2, "90th_percentile": 145.78, "count": "58" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 145.78, "10th_percentile": 145.44, "90th_percentile": 145.78, "count": "31" } ] } ] }, { "description": "HC (SUP SHELL A4388) DRAINABLE PCH W EX WEAR BARR", "code_information": [ { "code": "A4388", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 6.21, "maximum": 6.21, "payers_information": [ { "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" } ] } ] }, { "description": "HC PROTEIN E-PHORESIS/URINE/CSF", "code_information": [ { "code": "84166", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 275.63, "discounted_cash": 79.0, "minimum": 17.83, "maximum": 249.9964, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 147.21 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 180.38 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 144.3 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 180.38 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 180.38 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 165.29 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 17.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 17.83, "10th_percentile": 17.83, "90th_percentile": 17.83, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 67.2, "10th_percentile": 67.2, "90th_percentile": 77.7, "count": "1 through 10" } ] } ] }, { "description": "HC ASSAY OF ALDOSTERONE", "code_information": [ { "code": "82088", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 580.63, "discounted_cash": 168.0, "minimum": 40.75, "maximum": 526.6314, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 336.36 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 412.16 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 161.09, "10th_percentile": 161.09, "90th_percentile": 161.09, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 329.73 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 412.16 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 412.16 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 377.77 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 9.27, "10th_percentile": 9.27, "90th_percentile": 464.5, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 464.5, "10th_percentile": 464.5, "90th_percentile": 464.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 148.64, "10th_percentile": 148.64, "90th_percentile": 157.93, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 148.64, "10th_percentile": 148.64, "90th_percentile": 148.64, "count": "1 through 10" } ] } ] }, { "description": "HC ASSAY OF TOTAL ESTRADIOL", "code_information": [ { "code": "82670", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 350.63, "discounted_cash": 101.0, "minimum": 27.94, "maximum": 318.0214, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 215.42, "10th_percentile": 215.42, "90th_percentile": 215.42, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 230.65 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 282.62 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 226.1 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 282.62 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 282.62 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 259.02 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 27.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 280.5, "10th_percentile": 280.5, "90th_percentile": 280.5, "count": "22" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 89.76, "10th_percentile": 89.76, "90th_percentile": 89.76, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 254.41, "10th_percentile": 254.41, "90th_percentile": 256.94, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 89.76, "10th_percentile": 89.76, "90th_percentile": 89.76, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 89.76, "10th_percentile": 89.76, "90th_percentile": 89.76, "count": "1 through 10" } ] } ] }, { "description": "HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CCMCC", "code_information": [ { "code": "513", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8742.0, "minimum": 8742.79, "maximum": 18559.39, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18559.39 } ] } ] }, { "description": "Prednisolone Soln 15 MG/5ML", "drug_information": { "unit": 240.0, "type": "ML" }, "code_information": [ { "code": "00121088508", "type": "NDC" }, { "code": "J7510", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.04, "maximum": 2.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.04 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.8 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2.25 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.51 } ] } ] }, { "description": "COMPLICATED PEPTIC ULCER WITH CC", "code_information": [ { "code": "381", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6949.0, "minimum": 6949.39, "maximum": 12773.36, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12773.36 } ] } ] }, { "description": "TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC", "code_information": [ { "code": "083", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7173.0, "minimum": 7173.57, "maximum": 16455.06, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16455.06 } ] } ] }, { "description": "VAGINA, CERVIX AND VULVA PROCEDURES WITH CCMCC", "code_information": [ { "code": "746", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6949.0, "minimum": 6949.39, "maximum": 20478.64, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20478.64 } ] } ] }, { "description": "HC HELICOBACTER PYLORI", "code_information": [ { "code": "86677", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 114.69, "discounted_cash": 33.0, "minimum": 16.85, "maximum": 114.69, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 114.69 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 114.69 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 114.69 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 114.69 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 114.69 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 114.69 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.85, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR", "code_information": [ { "code": "518", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11881.0, "minimum": 11881.22, "maximum": 44058.95, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 44058.95 } ] } ] }, { "description": "THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH MCC", "code_information": [ { "code": "625", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11432.0, "minimum": 11432.87, "maximum": 35603.9, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 35603.9 } ] } ] }, { "description": "Methylene Blue IV Soln 50 MG/10ML (5 MG/ML)", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "00517037405", "type": "NDC" }, { "code": "Q9968", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 15.0885, "maximum": 22.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 18.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 22.5 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 22.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.09 } ] } ] }, { "description": "MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC", "code_information": [ { "code": "330", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10760.0, "minimum": 10760.35, "maximum": 28260.54, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28260.54 } ] } ] }, { "description": "HC (SUP SHELL A4357) BEDSID DRN BAG DAY/NGT W/WO TUBE EA", "code_information": [ { "code": "A4357", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 11.76, "maximum": 17.85, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.85 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.28 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 17.85 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 17.85 }, { "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" } ] } ] }, { "description": "Penicillin G Potassium For Inj 5000000 Unit", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00049052084", "type": "NDC" }, { "code": "J2540", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2.457, "maximum": 16.03, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.03 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.66 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2.93 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 3.66 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 3.66 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2.46 } ] } ] }, { "description": "HC ASSAY OF VANCOMYCIN", "code_information": [ { "code": "80202", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 447.81, "discounted_cash": 129.0, "minimum": 13.54, "maximum": 406.1637, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 121.68, "10th_percentile": 121.68, "90th_percentile": 121.68, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 111.82 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 137.02 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 109.61 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 137.02 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 137.02 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 125.52 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 13.54, "10th_percentile": 13.54, "90th_percentile": 13.54, "count": "1 through 10" } ] } ] }, { "description": "HC PATH CONSULT IN SURG,W FRZ SEC", "code_information": [ { "code": "88331", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 490.94, "discounted_cash": 142.0, "minimum": 142.3726, "maximum": 474.6496, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 474.65 } ] } ] }, { "description": "HC GROUP THERAPEUTIC PROCEDURES", "code_information": [ { "code": "97150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 135.0, "discounted_cash": 39.0, "minimum": 17.27, "maximum": 122.445, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "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" } ] } ] }, { "description": "HC BLD CLOT FACTOR VIII TEST, VW FC, MULTIMET ANAL", "code_information": [ { "code": "85247", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 483.75, "discounted_cash": 140.0, "minimum": 22.94, "maximum": 438.7613, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 189.44 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 232.12 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 185.7 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 232.12 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 232.12 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 212.67 }, { "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" } ] } ] }, { "description": "HC IMMUNOASSAY, TUMOR ANTIGEN, CA 19-9", "code_information": [ { "code": "86301", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 138.75, "discounted_cash": 40.0, "minimum": 20.81, "maximum": 138.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 138.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 138.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 138.75 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 138.75 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 138.75 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 138.75 }, { "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 Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 35.52, "10th_percentile": 33.52, "90th_percentile": 35.62, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 33.52, "10th_percentile": 33.52, "90th_percentile": 33.52, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 35.52, "10th_percentile": 35.52, "90th_percentile": 35.52, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 35.62, "10th_percentile": 33.52, "90th_percentile": 35.62, "count": "1 through 10" } ] } ] }, { "description": "HC X-RAY JOINT SURVEY SINGLE VW", "code_information": [ { "code": "77077", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 390.63, "discounted_cash": 113.0, "minimum": 105.83, "maximum": 354.3014, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 107.96 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 132.29 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 105.83 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 132.29 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 132.29 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 259.44 } ] } ] }, { "description": "MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC", "code_information": [ { "code": "809", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7397.0, "minimum": 7397.74, "maximum": 52483.617, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 7397.74, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 25725.84, "10th_percentile": 25725.84, "90th_percentile": 25725.84, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14923.67 } ] } ] }, { "description": "TRANSURETHRAL PROCEDURES WITH MCC", "code_information": [ { "code": "668", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16140.0, "minimum": 16140.53, "maximum": 34423.82, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34423.82 } ] } ] }, { "description": "HC ULTRASOUND,SCROTUM & CONTENTS", "code_information": [ { "code": "76870", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1040.0, "discounted_cash": 301.0, "minimum": 301.6, "maximum": 943.28, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 638.98, "10th_percentile": 638.98, "90th_percentile": 638.98, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 282.6, "10th_percentile": 282.6, "90th_percentile": 282.6, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 427.24 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 272.24, "10th_percentile": 272.24, "90th_percentile": 272.24, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 341.79 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 427.24 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 427.24 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 529.98, "10th_percentile": 500.05, "90th_percentile": 529.98, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 628.86, "10th_percentile": 628.86, "90th_percentile": 628.86, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 594.96 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 639.68, "10th_percentile": 639.68, "90th_percentile": 639.68, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 832.0, "10th_percentile": 832.0, "90th_percentile": 832.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 251.2, "10th_percentile": 251.2, "90th_percentile": 266.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 719.06, "10th_percentile": 719.06, "90th_percentile": 754.62, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 266.24, "10th_percentile": 266.24, "90th_percentile": 290.45, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 266.24, "10th_percentile": 266.24, "90th_percentile": 266.9, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 266.24, "10th_percentile": 266.24, "90th_percentile": 266.24, "count": "1 through 10" } ] } ] }, { "description": "POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC", "code_information": [ { "code": "918", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5380.0, "minimum": 5380.18, "maximum": 16098.345, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10104.33 } ] } ] }, { "description": "HC ASSAY OF PROGESTERONE", "code_information": [ { "code": "84144", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 275.31, "discounted_cash": 79.0, "minimum": 20.86, "maximum": 249.7062, "payers_information": [ { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 220.25, "10th_percentile": 220.25, "90th_percentile": 220.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 70.48, "10th_percentile": 70.48, "90th_percentile": 70.48, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 201.75, "10th_percentile": 201.75, "90th_percentile": 201.75, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 70.48, "10th_percentile": 70.48, "90th_percentile": 70.48, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 172.19 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 211.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 168.8 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 211.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 211.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 193.38 } ] } ] }, { "description": "HC US,PREGNANT UTERUS,LIMITED, 1/> FETUSES", "code_information": [ { "code": "76815", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 677.81, "discounted_cash": 196.0, "minimum": 196.5649, "maximum": 614.7737, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 415.3, "10th_percentile": 415.3, "90th_percentile": 415.3, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 287.82 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 230.25 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 287.82 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 287.82 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 428.6 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 510.25, "10th_percentile": 510.25, "90th_percentile": 510.25, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 490.46, "10th_percentile": 490.46, "90th_percentile": 490.46, "count": "1 through 10" } ] } ] }, { "description": "HC ASSAY OF LIPASE", "code_information": [ { "code": "83690", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 118.13, "discounted_cash": 34.0, "minimum": 6.89, "maximum": 107.1439, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 67.66, "10th_percentile": 67.66, "90th_percentile": 72.58, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 34.02, "10th_percentile": 34.02, "90th_percentile": 34.02, "count": "17" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 56.87 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 69.69 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 32.77, "10th_percentile": 32.77, "90th_percentile": 32.77, "count": "23" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 55.75 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 69.69 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 69.69 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 75.69, "10th_percentile": 75.69, "90th_percentile": 77.49, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 74.28, "10th_percentile": 74.28, "90th_percentile": 75.7, "count": "12" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 63.87 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 94.5, "10th_percentile": 51.32, "90th_percentile": 94.5, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 21.64, "10th_percentile": 21.64, "90th_percentile": 21.97, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 94.5, "10th_percentile": 94.5, "90th_percentile": 94.5, "count": "345" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 30.24, "10th_percentile": 30.24, "90th_percentile": 30.24, "count": "62" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 85.71, "10th_percentile": 75.53, "90th_percentile": 86.56, "count": "21" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 30.24, "10th_percentile": 30.24, "90th_percentile": 30.24, "count": "70" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 30.24, "10th_percentile": 30.24, "90th_percentile": 32.13, "count": "45" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 30.24, "10th_percentile": 30.24, "90th_percentile": 32.13, "count": "26" } ] } ] }, { "description": "RECTAL RESECTION WITH CC", "code_information": [ { "code": "333", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7846.0, "minimum": 7846.09, "maximum": 27612.15, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27612.15 } ] } ] }, { "description": "HC CT SCAN LUMBAR SPINE W CONTRAST", "code_information": [ { "code": "72132", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2607.19, "discounted_cash": 756.0, "minimum": 650.0, "maximum": 2364.7213, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1381.79 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1105.43 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1381.79 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1381.79 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 984.09 } ] } ] }, { "description": "HC (SUP SHELL L3933) FO W/O JOINTS CF", "code_information": [ { "code": "L3933", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 232.89, "maximum": 232.89, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 232.89, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC STRAPPING UNNA BOOT", "code_information": [ { "code": "29580", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 884.69, "discounted_cash": 256.0, "minimum": 256.5601, "maximum": 802.4138, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 37.66, "10th_percentile": 37.66, "90th_percentile": 204.22, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 437.25, "10th_percentile": 437.25, "90th_percentile": 437.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 139.92, "10th_percentile": 133.28, "90th_percentile": 139.92, "count": "15" } ] } ] }, { "description": "HC MRI, FACE, NECK, COMBO", "code_information": [ { "code": "70543", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3309.69, "discounted_cash": 959.0, "minimum": 900.0, "maximum": 3001.8888, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2670.71 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2136.55 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2670.71 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2670.71 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2097.93 } ] } ] }, { "description": "HC UNLISTED MR PROCEDURE", "code_information": [ { "code": "76498", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2223.75, "discounted_cash": 644.0, "minimum": 644.8875, "maximum": 2016.9413, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 } ] } ] }, { "description": "HC RBC LEUKOREDUCED IRRADIATED, PER UNIT", "code_information": [ { "code": "P9040", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 993.44, "minimum": 288.0976, "maximum": 901.0501, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 286.11, "10th_percentile": 286.11, "90th_percentile": 286.11, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 508.96, "10th_percentile": 508.96, "90th_percentile": 508.96, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 275.62, "10th_percentile": 275.62, "90th_percentile": 275.62, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 254.32, "10th_percentile": 254.32, "90th_percentile": 270.22, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 254.32, "10th_percentile": 254.32, "90th_percentile": 254.32, "count": "1 through 10" } ] } ] }, { "description": "CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITH MCC", "code_information": [ { "code": "323", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10087.0, "minimum": 10087.83, "maximum": 51015.63, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 51015.63 } ] } ] }, { "description": "HC ULTRASOUND ELASTOGRAPHY FIRST TARGET LESION", "code_information": [ { "code": "76982", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 677.5, "discounted_cash": 196.0, "minimum": 196.475, "maximum": 614.4925, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 552.69 } ] } ] }, { "description": "OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC", "code_information": [ { "code": "818", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6052.0, "minimum": 6052.7, "maximum": 13665.79, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13665.79 } ] } ] }, { "description": "HC X-RAY ANKLE 2 VW", "code_information": [ { "code": "73600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 389.69, "discounted_cash": 113.0, "minimum": 72.92, "maximum": 353.4488, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 74.39 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 91.15 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 72.92 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 91.15 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 91.15 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 208.63 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 294.0, "10th_percentile": 294.0, "90th_percentile": 294.0, "count": "1 through 10" } ] } ] }, { "description": "NONSPECIFIC CEREBROVASCULAR DISORDERS WITH CC", "code_information": [ { "code": "071", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7397.0, "minimum": 6658.7064, "maximum": 12095.49, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 7397.74, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 6431.46, "10th_percentile": 6431.46, "90th_percentile": 6431.46, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12095.49 } ] } ] }, { "description": "HC (SUP SHELL L8440) SHRINKER BELOW KNEE", "code_information": [ { "code": "L8440", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 57.58, "maximum": 57.58, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 57.58, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC INJ, THERAP/PROPH/DIAGN, IV PUSH EA ADD SAME DX", "code_information": [ { "code": "96376", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 410.94, "discounted_cash": 119.0, "minimum": 119.1726, "maximum": 372.7226, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 470.77, "10th_percentile": 235.39, "90th_percentile": 767.55, "count": "1 through 10" } ] } ] }, { "description": "HC IMMUNOFLUOR EA ADD SINGLE ANTIBODY STAIN", "code_information": [ { "code": "88350", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 248.44, "discounted_cash": 72.0, "minimum": 72.0476, "maximum": 248.44, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 248.44 } ] } ] }, { "description": "RESPIRATORY NEOPLASMS WITH MCC", "code_information": [ { "code": "180", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10760.0, "minimum": 10760.35, "maximum": 20819.34, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20819.34 } ] } ] }, { "description": "HC (SUP SHELL L8001) BREAST PROSTHESIS BRA & FORM", "code_information": [ { "code": "L8001", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 150.77, "maximum": 150.77, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 150.77, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6212) FOAM DRG <=16 SQ IN W/BORDER - A6212 - RU272044", "code_information": [ { "code": "A6212", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 13.84, "maximum": 13.84, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC EGFR GENE COM VARIANTS", "code_information": [ { "code": "81235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2628.13, "discounted_cash": 762.0, "minimum": 324.58, "maximum": 2628.13, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2174.46 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2628.13 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2131.58 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2628.13 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2628.13 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2628.13 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 324.58, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC PARATHYROID IMAGING W/TOMOGRAPHIC SPECT & CT", "code_information": [ { "code": "78072", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1756.25, "discounted_cash": 509.0, "minimum": 509.3125, "maximum": 1756.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1381.54 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1692.86 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1354.28 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1692.86 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1692.86 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1756.25 } ] } ] }, { "description": "HC BACTERIA CULTURE SCREEN", "code_information": [ { "code": "87081", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 155.31, "discounted_cash": 45.0, "minimum": 6.63, "maximum": 140.8662, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 83.95, "10th_percentile": 83.95, "90th_percentile": 83.95, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 42.21, "10th_percentile": 42.21, "90th_percentile": 44.73, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 47.88 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 58.67 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 40.67, "10th_percentile": 40.67, "90th_percentile": 40.67, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 46.94 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 58.67 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 58.67 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 74.69, "10th_percentile": 74.69, "90th_percentile": 96.15, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 93.93, "10th_percentile": 93.93, "90th_percentile": 93.93, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 61.46 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 39.87, "10th_percentile": 39.87, "90th_percentile": 39.87, "count": "1 through 10" }, { "payer_name": "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 117.25, "10th_percentile": 117.25, "90th_percentile": 124.25, "count": "163" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 39.76, "10th_percentile": 37.52, "90th_percentile": 39.87, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 107.4, "10th_percentile": 80.95, "90th_percentile": 112.69, "count": "15" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 39.76, "10th_percentile": 37.52, "90th_percentile": 39.76, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 39.76, "10th_percentile": 37.52, "90th_percentile": 39.76, "count": "1 through 10" } ] } ] }, { "description": "INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC", "code_information": [ { "code": "728", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6501.0, "minimum": 6501.05, "maximum": 9563.22, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9563.22 } ] } ] }, { "description": "HC PERQ XHEPATIC PORTO+DYNAMIC", "code_information": [ { "code": "75885", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9553.75, "discounted_cash": 2770.0, "minimum": 611.8963, "maximum": 8665.2512, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 846.11 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1036.78 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 829.42 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1036.78 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1036.78 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 611.9 } ] } ] }, { "description": "HC MRA SPINAL CANAL W CONTRAST - 72159 - 61800010", "code_information": [ { "code": "72159", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2284.38, "discounted_cash": 662.0, "minimum": 662.4702, "maximum": 2284.38, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2284.38 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2212.29 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2284.38 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2284.38 }, { "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 ORGANIC ACIDS TOTAL QUANT", "code_information": [ { "code": "83918", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 556.56, "discounted_cash": 161.0, "minimum": 23.6, "maximum": 504.7999, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 135.9 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 166.53 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 133.22 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 166.53 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 166.53 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 218.78 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 23.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF CHROMIUM", "code_information": [ { "code": "82495", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 133.13, "discounted_cash": 38.0, "minimum": 20.28, "maximum": 133.13, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 133.13 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 133.13 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 133.13 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 133.13 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 133.13 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 133.13 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 106.5, "10th_percentile": 106.5, "90th_percentile": 106.5, "count": "1 through 10" } ] } ] }, { "description": "HC X-RAY SIALOGRAM", "code_information": [ { "code": "70390", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 988.75, "discounted_cash": 286.0, "minimum": 286.7375, "maximum": 896.7962, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 319.47 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 391.46 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 313.16 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 391.46 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 391.46 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 829.0 } ] } ] }, { "description": "HC US PELVIS NONOBST LIMITED/FU", "code_information": [ { "code": "76857", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 677.81, "discounted_cash": 196.0, "minimum": 196.5649, "maximum": 614.7737, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 397.56, "10th_percentile": 397.56, "90th_percentile": 397.56, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 199.89, "10th_percentile": 199.89, "90th_percentile": 199.89, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 311.06 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 204.09, "10th_percentile": 204.09, "90th_percentile": 204.09, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 248.85 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 311.06 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 311.06 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 222.77 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 188.79, "10th_percentile": 188.32, "90th_percentile": 491.92, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 588.5, "10th_percentile": 555.25, "90th_percentile": 588.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 188.32, "10th_percentile": 177.68, "90th_percentile": 188.79, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 533.77, "10th_percentile": 533.77, "90th_percentile": 533.77, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 188.32, "10th_percentile": 177.68, "90th_percentile": 188.79, "count": "1 through 10" } ] } ] }, { "description": "INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "855", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6501.0, "minimum": 6501.05, "maximum": 17650.46, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17650.46 } ] } ] }, { "description": "HC MRI, JOINT UPPER EXTREM COMBO", "code_information": [ { "code": "73223", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3750.94, "discounted_cash": 1087.0, "minimum": 900.0, "maximum": 3402.1026, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2670.71 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2136.55 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2670.71 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2670.71 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2515.26 } ] } ] }, { "description": "HC GONADOTROPIN (FSH)", "code_information": [ { "code": "83001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 267.19, "discounted_cash": 77.0, "minimum": 18.58, "maximum": 242.3413, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 164.16, "10th_percentile": 164.16, "90th_percentile": 164.16, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 153.43 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 188.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 150.4 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 188.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 188.0 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 136.16, "10th_percentile": 136.16, "90th_percentile": 136.16, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 172.25 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 213.75, "10th_percentile": 213.75, "90th_percentile": 213.75, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 68.4, "10th_percentile": 68.4, "90th_percentile": 68.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 193.87, "10th_percentile": 193.87, "90th_percentile": 195.8, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 68.4, "10th_percentile": 68.4, "90th_percentile": 79.09, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 68.4, "10th_percentile": 68.4, "90th_percentile": 68.4, "count": "1 through 10" } ] } ] }, { "description": "HC MRI BREAST WITHOUT&WITH CONTRAST W/CAD BILATERAL - 77049 - 61077049", "code_information": [ { "code": "77049", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1173.75, "discounted_cash": 340.0, "minimum": 340.3875, "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": "CONCUSSION WITH MCC", "code_information": [ { "code": "088", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7621.0, "minimum": 7621.92, "maximum": 15936.34, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15936.34 } ] } ] }, { "description": "HC ANTISTREPTOLYSIN O TITER", "code_information": [ { "code": "86060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 123.44, "discounted_cash": 35.0, "minimum": 7.3, "maximum": 111.9601, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 60.26 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 73.84 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 59.07 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 73.84 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 73.84 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 67.67 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L2795) KNEE CONTROL FULL KNEECAP", "code_information": [ { "code": "L2795", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 130.19, "maximum": 130.19, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 130.19, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC FLUORESCENT ANTIBODY; SCREEN", "code_information": [ { "code": "86255", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 254.06, "discounted_cash": 73.0, "minimum": 12.05, "maximum": 230.4324, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 148.61, "10th_percentile": 148.61, "90th_percentile": 148.61, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 99.49 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 121.92 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 97.53 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 121.92 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 121.92 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 317.04, "10th_percentile": 317.04, "90th_percentile": 317.04, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 111.71 }, { "payer_name": "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 191.75, "10th_percentile": 150.0, "90th_percentile": 203.25, "count": "14" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 61.36, "10th_percentile": 19.76, "90th_percentile": 61.36, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 184.35, "10th_percentile": 184.35, "90th_percentile": 184.35, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 65.04, "10th_percentile": 21.55, "90th_percentile": 281.36, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 65.04, "10th_percentile": 65.04, "90th_percentile": 65.04, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL C9355 )NEUROMATRIX NERVE CUFF, CM", "code_information": [ { "code": "C9355", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 574.056, "maximum": 574.056, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 574.06 } ] } ] }, { "description": "HC COMPUTED TOMOGRAPHY THORAX LW DOSE LNG CA SCR C-", "code_information": [ { "code": "71271", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 481.25, "discounted_cash": 139.0, "minimum": 139.5625, "maximum": 481.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 260.09, "10th_percentile": 260.09, "90th_percentile": 281.52, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 481.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 481.25 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 123.49, "10th_percentile": 123.49, "90th_percentile": 123.49, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL A6254) ABSORPT DRG <=16 SQ IN W/BDR - A6254 - RU272056", "code_information": [ { "code": "A6254", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.7, "maximum": 1.7, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.7, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC DEOXYRIBONUCLEASE, ANTIBODY", "code_information": [ { "code": "86215", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 210.0, "discounted_cash": 60.0, "minimum": 13.25, "maximum": 190.47, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 109.39 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 134.04 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 107.23 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 134.04 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 134.04 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 122.83 }, { "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" } ] } ] }, { "description": "HC BLOOD PH", "code_information": [ { "code": "82800", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 124.69, "discounted_cash": 36.0, "minimum": 11.0, "maximum": 113.0938, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 33.21, "10th_percentile": 33.21, "90th_percentile": 33.21, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 69.93 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 85.69 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 68.55 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 85.69 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 85.69 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 101.98 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 92.25, "10th_percentile": 92.25, "90th_percentile": 92.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 29.52, "10th_percentile": 29.52, "90th_percentile": 29.52, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 31.37, "10th_percentile": 31.37, "90th_percentile": 31.37, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL Q4122) DERMACELL", "code_information": [ { "code": "Q4122", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 323.9775, "maximum": 1392.05, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1392.05 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 483.17 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 386.53 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 483.17 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 483.17 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 323.98 } ] } ] }, { "description": "NON-EXTENSIVE BURNS", "code_information": [ { "code": "935", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8742.0, "minimum": 8742.79, "maximum": 24285.3, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24285.3 } ] } ] }, { "description": "HC (SUP SHELL L0623) SIO RIG PNL PELV/SAC PRE OTS", "code_information": [ { "code": "L0623", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 137.13, "maximum": 137.13, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 137.13, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL Q4206) FLUID FLOW OR FLUID GF 1 CC", "code_information": [ { "code": "Q4206", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 7666.73, "maximum": 9583.51, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9583.51 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7666.73 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 9583.51 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 9583.51 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7711.2 } ] } ] }, { "description": "RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC", "code_information": [ { "code": "177", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9863.0, "minimum": 9863.66, "maximum": 18422.64, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 9863.66, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 2241.74, "10th_percentile": 2241.74, "90th_percentile": 2241.74, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18422.64 } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CCMCC", "code_information": [ { "code": "192", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4707.0, "minimum": 4707.65, "maximum": 9827.622, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7568.53 } ] } ] }, { "description": "HC (SUP SHELL A4314) CATH W/DRAINAGE 2-WAY LATEX", "code_information": [ { "code": "A4314", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 30.63, "maximum": 30.63, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 30.63, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L1960) AFO POS SOLID ANK PLASTIC MO", "code_information": [ { "code": "L1960", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 849.26, "maximum": 849.26, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 849.26, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MAJOR CHEST PROCEDURES WITH MCC", "code_information": [ { "code": "163", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14122.0, "minimum": 14122.96, "maximum": 52835.85, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 52835.85 } ] } ] }, { "description": "NONTRAUMATIC STUPOR AND COMA WITH MCC", "code_information": [ { "code": "080", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10536.0, "minimum": 10536.18, "maximum": 21338.05, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21338.05 } ] } ] }, { "description": "OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "750", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4259.0, "minimum": 4259.31, "maximum": 17398.18, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17398.18 } ] } ] }, { "description": "HC ASSAY OF GAMMAGLOBULIN IGA, IGD, IGG, IGM, EACH", "code_information": [ { "code": "82784", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 124.69, "discounted_cash": 36.0, "minimum": 9.3, "maximum": 113.0938, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 87.17, "10th_percentile": 87.17, "90th_percentile": 87.17, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 43.83, "10th_percentile": 36.54, "90th_percentile": 80.37, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 61.39 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 75.23 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 35.2, "10th_percentile": 35.2, "90th_percentile": 77.43, "count": "12" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 60.18 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 75.23 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 75.23 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 77.55, "10th_percentile": 77.55, "90th_percentile": 77.55, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 86.22 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 84.08, "10th_percentile": 41.4, "90th_percentile": 101.5, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 23.59, "10th_percentile": 23.59, "90th_percentile": 23.59, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 121.75, "10th_percentile": 101.5, "90th_percentile": 345.0, "count": "22" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 38.96, "10th_percentile": 32.48, "90th_percentile": 75.91, "count": "31" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 92.97, "10th_percentile": 92.06, "90th_percentile": 127.65, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 71.44, "10th_percentile": 38.96, "90th_percentile": 82.6, "count": "53" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 71.44, "10th_percentile": 38.96, "90th_percentile": 110.4, "count": "25" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 38.96, "10th_percentile": 38.96, "90th_percentile": 71.44, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL L4392) REPLACE AFO SOFT INTERFACE", "code_information": [ { "code": "L4392", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 29.48, "maximum": 29.48, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 29.48, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC MRI BREAST WITHOUT CONTRAST MATERIAL UNILATERAL", "code_information": [ { "code": "77046", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1235.31, "discounted_cash": 358.0, "minimum": 358.2399, "maximum": 1235.31, "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": 1235.31 } ] } ] }, { "description": "HC DOPPLER COLOR FLOW VELOCITY MAP (93325)", "code_information": [ { "code": "93325", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 665.63, "discounted_cash": 193.0, "minimum": 193.0327, "maximum": 603.7264, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 412.69, "10th_percentile": 412.69, "90th_percentile": 412.69, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 341.01, "10th_percentile": 341.01, "90th_percentile": 347.56, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 184.67, "10th_percentile": 184.67, "90th_percentile": 184.67, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 79.93, "median_amount": 425.63, "10th_percentile": 425.63, "90th_percentile": 425.63, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 532.5, "10th_percentile": 532.5, "90th_percentile": 532.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 532.5, "10th_percentile": 532.5, "90th_percentile": 532.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 181.05, "10th_percentile": 170.4, "90th_percentile": 181.05, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 170.4, "10th_percentile": 34.08, "90th_percentile": 726.12, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 170.4, "10th_percentile": 170.4, "90th_percentile": 170.4, "count": "1 through 10" } ] } ] }, { "description": "OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CCMCC", "code_information": [ { "code": "965", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5604.0, "minimum": 5604.35, "maximum": 11087.54, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11087.54 } ] } ] }, { "description": "HC ANTIDEPRESSANTS NOT OTHERWISE SPECIFIED - G0480 - 31080338", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 438.13, "minimum": 33.0774, "maximum": 1060.8233, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 438.13 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 438.13 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 438.13 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 438.13 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 438.13 }, { "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" } ] } ] }, { "description": "HC (SUP SHELL Q4126) MEMODERM/DERMA/TRANZ/INTEGUP", "code_information": [ { "code": "Q4126", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 199.395, "maximum": 1218.19, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1218.19 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 297.37 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 237.89 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 297.37 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 297.37 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 199.4 } ] } ] }, { "description": "HC GARDNER VAG DNA DIR PROBE", "code_information": [ { "code": "87510", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 81.88, "discounted_cash": 23.0, "minimum": 20.05, "maximum": 81.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 44.21, "10th_percentile": 44.21, "90th_percentile": 44.21, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 23.58, "10th_percentile": 22.23, "90th_percentile": 23.58, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 81.88 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 81.88 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 22.72, "10th_percentile": 22.72, "90th_percentile": 22.72, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 81.88 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 81.88 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 81.88 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 39.33, "10th_percentile": 39.33, "90th_percentile": 41.72, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 51.48, "10th_percentile": 49.47, "90th_percentile": 51.48, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 81.88 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 24.06, "10th_percentile": 24.06, "90th_percentile": 24.06, "count": "1 through 10" }, { "payer_name": "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 65.5, "10th_percentile": 61.75, "90th_percentile": 65.5, "count": "127" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 20.96, "10th_percentile": 19.76, "90th_percentile": 20.96, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 59.41, "10th_percentile": 52.35, "90th_percentile": 59.41, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 19.76, "10th_percentile": 19.76, "90th_percentile": 20.96, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 20.96, "10th_percentile": 20.96, "90th_percentile": 21.0, "count": "1 through 10" } ] } ] }, { "description": "Methotrexate Sodium Tab 2.5 MG (Base Equiv)", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "51079067001", "type": "NDC" }, { "code": "J8610", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 16.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "Methylnaltrexone Bromide Inj 12 MG/0.6ML (20 MG/ML)", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "65649055107", "type": "NDC" }, { "code": "J2212", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 4.5675, "maximum": 13.69, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.69 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.81 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.45 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 6.81 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 6.81 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.57 } ] } ] }, { "description": "HC (SUP SHELL C9358) SURGIMEND, FETAL", "code_information": [ { "code": "C9358", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 63.6615, "maximum": 63.6615, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 63.66 } ] } ] }, { "description": "OTHER O.R. PROCEDURES FOR INJURIES WITH MCC", "code_information": [ { "code": "907", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15243.0, "minimum": 15243.83, "maximum": 45261.43, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 45261.43 } ] } ] }, { "description": "PENIS PROCEDURES WITH CCMCC", "code_information": [ { "code": "709", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8966.0, "minimum": 8966.96, "maximum": 27434.14, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27434.14 } ] } ] }, { "description": "HC DRUG ASSAY EVEROLIMUS", "code_information": [ { "code": "80169", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1002.5, "discounted_cash": 290.0, "minimum": 13.73, "maximum": 909.2675, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 56.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 68.92 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 55.14 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 68.92 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 68.92 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 127.28 }, { "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" } ] } ] }, { "description": "HC DEHYDROEPIANDROSTERONE", "code_information": [ { "code": "82626", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 364.38, "discounted_cash": 105.0, "minimum": 25.27, "maximum": 330.4927, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 104.94, "10th_percentile": 104.94, "90th_percentile": 104.94, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 208.6 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 255.61 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 204.49 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 255.61 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 255.61 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 234.27 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 25.27, "additional_payer_notes": "100.00% 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": 76.8, "median_amount": 4081.54, "10th_percentile": 4081.54, "90th_percentile": 4081.54, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 225.67, "10th_percentile": 225.67, "90th_percentile": 2654.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 4235.75, "10th_percentile": 4235.75, "90th_percentile": 4235.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 456.56, "10th_percentile": 456.56, "90th_percentile": 485.1, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 1099.2, "10th_percentile": 377.16, "90th_percentile": 3724.91, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 381.25, "10th_percentile": 381.25, "90th_percentile": 381.25, "count": "1 through 10" } ] } ] }, { "description": "HC SPLEEN IMAGING", "code_information": [ { "code": "78185", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 788.13, "discounted_cash": 228.0, "minimum": 228.5577, "maximum": 788.13, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 659.4 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 788.13 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 646.39 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 788.13 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 788.13 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 788.13 } ] } ] }, { "description": "MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH MCC", "code_information": [ { "code": "435", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10760.0, "minimum": 10760.35, "maximum": 30491.01, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21652.82 } ] } ] }, { "description": "HC NERVE TEASING PREPARATIONS", "code_information": [ { "code": "88362", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 965.0, "discounted_cash": 279.0, "minimum": 279.85, "maximum": 965.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 965.0 } ] } ] }, { "description": "CELLULITIS WITHOUT MCC", "code_information": [ { "code": "603", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6949.0, "minimum": 6949.39, "maximum": 22847.5885, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "other", "standard_charge_dollar": 6949.39, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 2657.57, "10th_percentile": 2657.57, "90th_percentile": 2657.57, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "other", "standard_charge_dollar": 7262.12, "standard_charge_algorithm": "2342.62 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 12770.73, "10th_percentile": 4602.19, "90th_percentile": 100307.91, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "other", "standard_charge_dollar": 6949.39, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 2240.0, "10th_percentile": 2240.0, "90th_percentile": 2240.0, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10267.02 } ] } ] }, { "description": "HC FLOWCYTOMETRY/TC ADD-ON", "code_information": [ { "code": "88185", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 270.31, "discounted_cash": 78.0, "minimum": 78.3899, "maximum": 270.31, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 270.31 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 2541.0, "10th_percentile": 2541.0, "90th_percentile": 2783.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 890.56, "10th_percentile": 890.56, "90th_percentile": 890.56, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 890.56, "10th_percentile": 890.56, "90th_percentile": 890.56, "count": "1 through 10" } ] } ] }, { "description": "HC INTRA-ARTERIAL PARTICULATE ADMIN", "code_information": [ { "code": "79445", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 910.94, "discounted_cash": 264.0, "minimum": 264.1726, "maximum": 826.2226, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 409.95 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 502.33 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 401.86 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 502.33 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 502.33 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 741.58 } ] } ] }, { "description": "HC X-RAY LUMBAR SPINE 6+ VW", "code_information": [ { "code": "72114", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 984.06, "discounted_cash": 285.0, "minimum": 203.05, "maximum": 892.5424, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 267.39, "10th_percentile": 267.39, "90th_percentile": 267.39, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 207.14 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 253.82 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 273.02, "10th_percentile": 273.02, "90th_percentile": 273.02, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 203.05 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 253.82 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 253.82 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 397.6 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 742.75, "10th_percentile": 742.75, "90th_percentile": 742.75, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 237.68, "10th_percentile": 237.68, "90th_percentile": 237.68, "count": "1 through 10" } ] } ] }, { "description": "Desmopressin Acetate Inj 4 MCG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "69918089910", "type": "NDC" }, { "code": "J2597", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 14.1435, "maximum": 189.62, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 189.62 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.09 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 16.87 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 21.09 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 21.09 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.14 } ] } ] }, { "description": "Acyclovir Sodium IV Soln 50 MG/ML", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "55150015410", "type": "NDC" }, { "code": "J0133", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC (SUP SHELL A5072) URINARY POUCH W/O BARRIER", "code_information": [ { "code": "A5072", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 5.04, "maximum": 5.04, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF PYRUVATE", "code_information": [ { "code": "84210", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 372.19, "discounted_cash": 107.0, "minimum": 14.48, "maximum": 337.5763, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 89.6 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 109.79 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 87.83 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 109.79 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 109.79 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 134.24 }, { "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" } ] } ] }, { "description": "HC RADEX SPINE CERVICAL 4 OR 5 VIEWS", "code_information": [ { "code": "72050", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 787.81, "discounted_cash": 228.0, "minimum": 143.02, "maximum": 714.5437, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 425.66, "10th_percentile": 425.66, "90th_percentile": 425.66, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 214.02, "10th_percentile": 214.02, "90th_percentile": 226.89, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 145.9 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 178.78 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 218.58, "10th_percentile": 206.17, "90th_percentile": 218.58, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 143.02 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 178.78 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 178.78 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 401.47, "10th_percentile": 401.47, "90th_percentile": 722.65, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 346.86 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 201.68, "10th_percentile": 83.7, "90th_percentile": 201.68, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 630.25, "10th_percentile": 594.5, "90th_percentile": 630.25, "count": "25" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 190.24, "10th_percentile": 190.24, "90th_percentile": 201.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 571.64, "10th_percentile": 571.64, "90th_percentile": 571.64, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 201.68, "10th_percentile": 106.42, "90th_percentile": 219.97, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 201.68, "10th_percentile": 201.68, "90th_percentile": 202.13, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 201.68, "10th_percentile": 201.68, "90th_percentile": 201.68, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL A4354) CATH INSERTION TRAY W/BAG", "code_information": [ { "code": "A4354", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 16.83, "maximum": 16.83, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.83, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CCMCC", "code_information": [ { "code": "063", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4931.0, "minimum": 4931.83, "maximum": 16549.37, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16549.37 } ] } ] }, { "description": "Betamethasone Sod Phosphate & Acetate Inj Susp 6 (3-3) MG/ML", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "78206011801", "type": "NDC" }, { "code": "J0702", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 21.5775, "maximum": 102.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 102.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 32.18 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 25.74 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 32.18 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 32.18 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.58 } ] } ] }, { "description": "HC ASSAY OF ERYTHROPOIETIN", "code_information": [ { "code": "82668", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 373.75, "discounted_cash": 108.0, "minimum": 18.79, "maximum": 338.9912, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 155.18 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 190.15 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 103.69, "10th_percentile": 103.69, "90th_percentile": 103.69, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 152.12 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 190.15 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 190.15 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 174.19 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 95.68, "10th_percentile": 95.68, "90th_percentile": 95.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 95.68, "10th_percentile": 95.68, "90th_percentile": 95.68, "count": "1 through 10" } ] } ] }, { "description": "HC X-RAY SACROILIAC JTS <3 VW", "code_information": [ { "code": "72200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 549.06, "discounted_cash": 159.0, "minimum": 78.67, "maximum": 497.9974, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 80.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 98.33 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 78.67 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 98.33 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 98.33 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 214.3 } ] } ] }, { "description": "HC RO 3-D RADIOTHERAPY PLAN DOSE-VOLUME HISTOGRAMS", "code_information": [ { "code": "77295", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8078.13, "discounted_cash": 2342.0, "minimum": 1834.77, "maximum": 7326.8639, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1871.7 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2293.47 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1834.77 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2293.47 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2293.47 } ] } ] }, { "description": "HC ASSAY OF AMITRIPTYLINE - 80335 - 30100408", "code_information": [ { "code": "80335", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 221.25, "discounted_cash": 64.0, "minimum": 46.3525, "maximum": 200.6738, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 46.35 } ] } ] }, { "description": "NONSPECIFIC CEREBROVASCULAR DISORDERS WITH MCC", "code_information": [ { "code": "070", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10087.0, "minimum": 3934.5943, "maximum": 19626.29, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 10087.83, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 4111.74, "10th_percentile": 4111.74, "90th_percentile": 4111.74, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19626.29 } ] } ] }, { "description": "HC ASSAY OF VIP", "code_information": [ { "code": "84586", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 674.38, "discounted_cash": 195.0, "minimum": 35.33, "maximum": 611.6627, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 157.61 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 193.12 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 154.5 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 193.12 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 193.12 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 327.53 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 35.33, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC ISLET CELL ANTIBODY", "code_information": [ { "code": "86341", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 193.75, "discounted_cash": 56.0, "minimum": 23.57, "maximum": 193.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 163.32 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 193.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 160.1 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 193.75 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 193.75 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 193.75 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 23.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 146.25, "10th_percentile": 146.25, "90th_percentile": 146.25, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 49.6, "10th_percentile": 49.6, "90th_percentile": 54.11, "count": "1 through 10" } ] } ] }, { "description": "HC MRI UPPER EXTREMITY W/CONTRAST", "code_information": [ { "code": "73219", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2698.75, "discounted_cash": 782.0, "minimum": 782.6375, "maximum": 2447.7663, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2120.1 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1696.07 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2120.1 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2120.1 }, { "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": 2241.75 } ] } ] }, { "description": "HC (SUP SHELL A6237) HYDROCOLLD DRG <=16 IN W/BDR", "code_information": [ { "code": "A6237", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 11.27, "maximum": 24.01, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.01 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 19.2 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 24.01 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 24.01 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.27, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAY", "code_information": [ { "code": "83519", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 678.44, "discounted_cash": 196.0, "minimum": 18.4, "maximum": 615.3451, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 136.67 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 109.34 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 136.67 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 136.67 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 170.58 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 182.0, "10th_percentile": 182.0, "90th_percentile": 182.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 43.04, "10th_percentile": 43.04, "90th_percentile": 43.04, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 55.68, "10th_percentile": 49.77, "90th_percentile": 58.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 58.24, "10th_percentile": 58.24, "90th_percentile": 58.24, "count": "1 through 10" } ] } ] }, { "description": "Alteplase For Inj 2 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "50242004164", "type": "NDC" }, { "code": "J2997", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 288.099, "maximum": 1287.85, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1287.85 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 429.66 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 343.72 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 429.66 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 429.66 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 288.1 } ] } ] }, { "description": "HC THYROID HORM UPTAKE/THYR HORM BINDING RATIO", "code_information": [ { "code": "84479", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 145.94, "discounted_cash": 42.0, "minimum": 6.47, "maximum": 132.3676, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 53.42 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 65.46 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 52.37 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 65.46 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 65.46 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 59.98 }, { "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" } ] } ] }, { "description": "HC (SUP SHELL A7030) CPAP FULL FACE MASK", "code_information": [ { "code": "A7030", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 118.14, "maximum": 118.14, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 118.14, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC NEUROMUSC REEDUCAT,1+ AREAS COMPLEX, EA 15 MIN", "code_information": [ { "code": "97112", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 147.5, "discounted_cash": 42.0, "minimum": 31.35, "maximum": 133.7825, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 31.35, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HEART FAILURE AND SHOCK WITHOUT CCMCC", "code_information": [ { "code": "293", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4707.0, "minimum": 2092.1723, "maximum": 6672.56, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 4707.65, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 2143.82, "10th_percentile": 2143.82, "90th_percentile": 2143.82, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6672.56 } ] } ] }, { "description": "HC OCCULT BLOOD STOOL", "code_information": [ { "code": "82270", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 75.63, "discounted_cash": 21.0, "minimum": 4.38, "maximum": 68.5964, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 26.85 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 32.9 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 32.9 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 32.9 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.6 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 4.38, "10th_percentile": 4.38, "90th_percentile": 4.38, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.38, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC INTRALUMINAL DILATION W IMG", "code_information": [ { "code": "74360", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1251.25, "discounted_cash": 362.0, "minimum": 362.8625, "maximum": 1134.8837, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 525.19 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 643.54 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 514.83 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 643.54 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 643.54 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 713.38 } ] } ] }, { "description": "HC (SUP SHELL Q4171) INTERFLY, 1 MG", "code_information": [ { "code": "Q4171", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 38.2095, "maximum": 56.98, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 56.98 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 45.59 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 56.98 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 56.98 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.21 } ] } ] }, { "description": "CARDIAC DEFIBRILLATOR IMPLANT WITH MCC", "code_information": [ { "code": "276", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13898.0, "minimum": 13898.79, "maximum": 70811.69, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 70811.69 } ] } ] }, { "description": "HC (SUP SHELL A4435) 1PC OST PCH DRAIN HGH OUTPUT", "code_information": [ { "code": "A4435", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 8.21, "maximum": 8.21, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "100.00% 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": 11.0, "minimum": 5.5, "maximum": 39.38, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 39.38 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 39.38 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 39.38 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 39.38 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 39.38 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.38 }, { "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" } ] } ] }, { "description": "HC TRIIODOTHYRONINE FREE ASSAY (FT-3)", "code_information": [ { "code": "84481", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 220.63, "discounted_cash": 63.0, "minimum": 16.94, "maximum": 200.1114, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 126.37, "10th_percentile": 126.37, "90th_percentile": 126.37, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 63.54, "10th_percentile": 63.54, "90th_percentile": 63.54, "count": "14" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 139.86 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 171.37 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 61.21, "10th_percentile": 61.21, "90th_percentile": 61.21, "count": "11" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 137.1 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 171.37 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 171.37 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 112.43, "10th_percentile": 112.43, "90th_percentile": 112.43, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 138.73, "10th_percentile": 138.73, "90th_percentile": 141.39, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 157.04 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 167.04, "10th_percentile": 122.87, "90th_percentile": 176.5, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 176.5, "10th_percentile": 176.5, "90th_percentile": 176.5, "count": "32" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 56.48, "10th_percentile": 56.48, "90th_percentile": 60.01, "count": "29" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 160.09, "10th_percentile": 160.09, "90th_percentile": 161.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 56.48, "10th_percentile": 56.48, "90th_percentile": 65.31, "count": "15" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 56.48, "10th_percentile": 56.48, "90th_percentile": 60.01, "count": "13" } ] } ] }, { "description": "Testosterone Cypionate IM Inj in Oil 200 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00409656201", "type": "NDC" }, { "code": "J1071", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC (SUP SHELL Q4162) WNDEX FLW, BIOSKN FLW, 0.5CC", "code_information": [ { "code": "Q4162", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 5890.5, "maximum": 29312.43, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 29312.43 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5890.5 } ] } ] }, { "description": "Measles-Mumps-Rubella Virus Vaccines For Inj Soln", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00006468101", "type": "NDC" }, { "code": "90707", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 304.668, "maximum": 1057.52, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1057.52 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 454.37 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 363.49 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 454.37 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 454.37 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 304.67 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 0.01, "10th_percentile": 0.01, "90th_percentile": 0.01, "count": "1 through 10" } ] } ] }, { "description": "HC ASSAY OF THYROID STIM IMMUNOGLOBULINS (TSI)", "code_information": [ { "code": "84445", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 550.63, "discounted_cash": 159.0, "minimum": 50.86, "maximum": 514.26, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 158.58, "10th_percentile": 158.58, "90th_percentile": 158.58, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 419.69 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 514.26 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 152.77, "10th_percentile": 152.77, "90th_percentile": 152.77, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 411.41 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 514.26 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 514.26 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 280.6, "10th_percentile": 280.6, "90th_percentile": 280.6, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 471.5 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 440.5, "10th_percentile": 440.5, "90th_percentile": 440.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 140.96, "10th_percentile": 140.96, "90th_percentile": 140.96, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 399.53, "10th_percentile": 399.53, "90th_percentile": 399.53, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 140.96, "10th_percentile": 140.96, "90th_percentile": 140.96, "count": "1 through 10" } ] } ] }, { "description": "HC IADNA HIV-1 AMPLIFIED PROBE & REVERSE TRANSCRPJ", "code_information": [ { "code": "87535", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 970.0, "discounted_cash": 281.0, "minimum": 35.09, "maximum": 879.79, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 214.99 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 263.43 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 210.75 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 263.43 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 263.43 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 325.3 }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 732.0, "10th_percentile": 732.0, "90th_percentile": 732.0, "count": "1 through 10" } ] } ] }, { "description": "HC ASSAY OF AMIKACIN", "code_information": [ { "code": "80150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 149.06, "discounted_cash": 43.0, "minimum": 15.08, "maximum": 149.06, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 124.42 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 149.06 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 121.97 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 149.06 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 149.06 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 139.8 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "RENAL FAILURE WITH CC", "code_information": [ { "code": "683", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6725.0, "minimum": 5563.2445, "maximum": 10324.79, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "other", "standard_charge_dollar": 7027.86, "standard_charge_algorithm": "2342.62 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 6801.9, "10th_percentile": 6801.9, "90th_percentile": 6801.9, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10324.79 } ] } ] }, { "description": "HC CTA H&N C+ W/NONCONTRAST IMG", "code_information": [ { "code": "70471", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1688.75, "discounted_cash": 489.0, "minimum": 489.7375, "maximum": 1531.6962, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 } ] } ] }, { "description": "HC MRA ABDOMEN ANGIO - C8902 - 61800003", "code_information": [ { "code": "C8902", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3124.69, "minimum": 900.0, "maximum": 2834.0938, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 } ] } ] }, { "description": "HC DEVELOPMENTAL SCREEN - 96110 - 44000053", "code_information": [ { "code": "96110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 449.06, "discounted_cash": 130.0, "minimum": 95.0, "maximum": 407.2974, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "HC (SUP SHELL Q4128) FLEXHD/ALLOPATCHHD/MATRIXHD", "code_information": [ { "code": "Q4128", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 77.0805, "maximum": 114.96, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 114.96 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 91.96 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 114.96 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 114.96 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 77.08 } ] } ] }, { "description": "HC SELF CARE MNGMENT TRAIN COMPLEX EA 15 MIN", "code_information": [ { "code": "97535", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 163.44, "discounted_cash": 47.0, "minimum": 30.91, "maximum": 148.2401, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 30.91, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITHOUT CCMCC", "code_information": [ { "code": "730", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4035.0, "minimum": 4035.13, "maximum": 7922.19, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7922.19 } ] } ] }, { "description": "Methylnaltrexone Bromide Soln Pref Syr 8 MG/0.4ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "65649055204", "type": "NDC" }, { "code": "J2212", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 4.5675, "maximum": 13.69, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.69 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.81 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.45 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 6.81 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 6.81 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.57 } ] } ] }, { "description": "KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CCMCC", "code_information": [ { "code": "489", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 2690.0, "minimum": 2690.09, "maximum": 13165.93, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13165.93 } ] } ] }, { "description": "HC IGH@ VARIABLE REGION SOMATIC MUTATION ANALYSIS", "code_information": [ { "code": "81263", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1281.25, "discounted_cash": 371.0, "minimum": 294.52, "maximum": 1281.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1281.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1281.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1281.25 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1281.25 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1281.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1281.25 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 294.52, "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": 5156.0, "minimum": 5156.0, "maximum": 14650.3735, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "other", "standard_charge_dollar": 5388.03, "standard_charge_algorithm": "2342.62 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 4102.56, "10th_percentile": 4102.56, "90th_percentile": 4102.56, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "other", "standard_charge_dollar": 5156.0, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 8960.0, "10th_percentile": 8960.0, "90th_percentile": 8960.0, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8673.15 } ] } ] }, { "description": "CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CCMCC", "code_information": [ { "code": "416", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6276.0, "minimum": 6276.87, "maximum": 16071.92, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16071.92 } ] } ] }, { "description": "NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC", "code_information": [ { "code": "097", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19503.0, "minimum": 19503.14, "maximum": 42579.44, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 42579.44 } ] } ] }, { "description": "Cefoxitin Sodium For IV Soln 1 GM", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "25021010910", "type": "NDC" }, { "code": "J0694", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 15.7815, "maximum": 56.28, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 56.28 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.54 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 18.83 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 23.54 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 23.54 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.78 } ] } ] }, { "description": "INBORN AND OTHER DISORDERS OF METABOLISM", "code_information": [ { "code": "642", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7621.0, "minimum": 7621.92, "maximum": 20805.831, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "other", "standard_charge_dollar": 7621.92, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 11200.0, "10th_percentile": 11200.0, "90th_percentile": 11200.0, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16765.11 } ] } ] }, { "description": "HC BLOOD CULTURE FOR BACTERIA", "code_information": [ { "code": "87040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 250.31, "discounted_cash": 72.0, "minimum": 10.32, "maximum": 227.0312, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 270.65, "10th_percentile": 270.65, "90th_percentile": 270.65, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 136.08, "10th_percentile": 68.04, "90th_percentile": 144.18, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 85.19 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 104.39 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 138.89, "10th_percentile": 65.55, "90th_percentile": 138.89, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 83.51 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 104.39 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 104.39 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 157.4, "10th_percentile": 157.4, "90th_percentile": 157.4, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.67 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 378.0, "10th_percentile": 378.0, "90th_percentile": 378.0, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 378.0, "10th_percentile": 189.0, "90th_percentile": 400.5, "count": "45" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 120.96, "10th_percentile": 60.48, "90th_percentile": 128.16, "count": "20" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 346.25, "10th_percentile": 181.63, "90th_percentile": 363.25, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 128.16, "10th_percentile": 64.08, "90th_percentile": 128.16, "count": "23" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 128.16, "10th_percentile": 64.08, "90th_percentile": 128.52, "count": "21" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 128.16, "10th_percentile": 60.48, "90th_percentile": 128.52, "count": "1 through 10" } ] } ] }, { "description": "COMPLICATED PEPTIC ULCER WITH MCC", "code_information": [ { "code": "380", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11432.0, "minimum": 11432.87, "maximum": 23132.34, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23132.34 } ] } ] }, { "description": "HC ARC BLOOD TYPING, ABO", "code_information": [ { "code": "86900", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 61.56, "discounted_cash": 17.0, "minimum": 17.8524, "maximum": 55.8349, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 35.26, "10th_percentile": 35.26, "90th_percentile": 35.26, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 24.59 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 30.13 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 24.11 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 30.13 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 30.13 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.72 } ] } ] }, { "description": "HC MAMMARY DUCTOGRAM, MULTIPLE", "code_information": [ { "code": "77054", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 722.19, "discounted_cash": 209.0, "minimum": 209.4351, "maximum": 655.0263, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 325.33 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 398.64 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 318.91 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 398.64 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 398.64 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 408.86 } ] } ] }, { "description": "HC KRAS GENE ANALYSIS ADDITIONAL VARIANT(S)", "code_information": [ { "code": "81276", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 989.38, "discounted_cash": 286.0, "minimum": 193.25, "maximum": 989.38, "payers_information": [ { "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": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 989.38 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 989.38 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 989.38 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 989.38 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 989.38 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 989.38 } ] } ] }, { "description": "Lidocaine HCl Local Preservative Free (PF) Inj 2%", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "63323049504", "type": "NDC" }, { "code": "J2003", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 12.77, "10th_percentile": 12.77, "90th_percentile": 13.54, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC ENZYME HISTOCHEMISTRY", "code_information": [ { "code": "88319", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 228.75, "discounted_cash": 66.0, "minimum": 66.3375, "maximum": 228.75, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 228.75 } ] } ] }, { "description": "HC RBC LEUKOCYTES REDUCED", "code_information": [ { "code": "P9016", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 993.44, "minimum": 288.0976, "maximum": 901.0501, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 286.11, "10th_percentile": 286.11, "90th_percentile": 572.22, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 508.96, "10th_percentile": 508.96, "90th_percentile": 508.96, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 275.62, "10th_percentile": 275.62, "90th_percentile": 551.24, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1589.5, "10th_percentile": 794.75, "90th_percentile": 2384.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 508.64, "10th_percentile": 508.64, "90th_percentile": 762.96, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 254.32, "10th_percentile": 254.32, "90th_percentile": 508.64, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 254.32, "10th_percentile": 254.32, "90th_percentile": 254.32, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 270.22, "10th_percentile": 254.32, "90th_percentile": 508.64, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL Q4110) PRIMATRIX", "code_information": [ { "code": "Q4110", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 206.0415, "maximum": 798.12, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 798.12 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 307.28 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 245.82 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 307.28 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 307.28 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 206.04 } ] } ] }, { "description": "HC US EXAM SPINAL CANAL", "code_information": [ { "code": "76800", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 796.56, "discounted_cash": 231.0, "minimum": 231.0024, "maximum": 796.56, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 337.83 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 270.26 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 337.83 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 337.83 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 796.56 } ] } ] }, { "description": "RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC", "code_information": [ { "code": "815", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6501.0, "minimum": 6501.05, "maximum": 25167.429, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11954.03 } ] } ] }, { "description": "TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC", "code_information": [ { "code": "605", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6052.0, "minimum": 6052.7, "maximum": 11684.898, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10798.71 } ] } ] }, { "description": "HC HERPES SIMPLEX TEST, TYPE 2", "code_information": [ { "code": "86696", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 314.06, "discounted_cash": 91.0, "minimum": 19.35, "maximum": 284.8524, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 159.76 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 195.76 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 156.61 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 195.76 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 195.76 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 179.38 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 251.25, "10th_percentile": 251.25, "90th_percentile": 251.25, "count": "1 through 10" } ] } ] }, { "description": "HC TB INTRADERMAL TEST", "code_information": [ { "code": "86580", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 46.56, "discounted_cash": 13.0, "minimum": 13.5024, "maximum": 46.56, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 46.56 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 36.0, "10th_percentile": 36.0, "90th_percentile": 38.25, "count": "1 through 10" } ] } ] }, { "description": "DENTAL AND ORAL DISEASES WITH CC", "code_information": [ { "code": "158", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6276.0, "minimum": 6276.87, "maximum": 10725.61, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10725.61 } ] } ] }, { "description": "Ziprasidone Mesylate For Inj 20 MG (Base Equivalent)", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "43598084811", "type": "NDC" }, { "code": "J3486", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 16.317, "maximum": 265.61, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 265.61 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.33 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 19.47 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 24.33 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 24.33 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.32 } ] } ] }, { "description": "FOOT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "505", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6052.0, "minimum": 6052.7, "maximum": 21135.28, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21135.28 } ] } ] }, { "description": "HC (SUP SHELL A6442) CONFORM BAND N/S W<3/YD", "code_information": [ { "code": "A6442", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "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" } ] } ] }, { "description": "MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC", "code_information": [ { "code": "329", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21072.0, "minimum": 21072.36, "maximum": 54188.05, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 54188.05 } ] } ] }, { "description": "Rituximab-pvvr IV Soln 100 MG/10ML (10 MG/ML)", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "00069023801", "type": "NDC" }, { "code": "Q5119", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 78.561, "maximum": 117.16, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 117.16 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 93.73 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 117.16 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 117.16 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 78.56 } ] } ] }, { "description": "NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CCMCC", "code_information": [ { "code": "099", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8518.0, "minimum": 8518.61, "maximum": 16061.31, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16061.31 } ] } ] }, { "description": "HC LACTOFERRIN, FECAL, QUAN", "code_information": [ { "code": "83631", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 613.13, "discounted_cash": 177.0, "minimum": 19.63, "maximum": 556.1089, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 162.02 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 198.53 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 158.82 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 198.53 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 198.53 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 181.98 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4358) URINARY LEG OR ABDOMEN BAG - A4358 - RU272031", "code_information": [ { "code": "A4358", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 8.43, "maximum": 8.43, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.43, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL V2632) POSTERIOR CHAMBER INTRAOCULAR LENS", "code_information": [ { "code": "V2632", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 145.73, "maximum": 145.73, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 145.73, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "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": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "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" } ] } ] }, { "description": "VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CCMCC", "code_information": [ { "code": "807", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4483.0, "minimum": 4483.48, "maximum": 7948.13, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7948.13 } ] } ] }, { "description": "EXTRACRANIAL PROCEDURES WITH MCC", "code_information": [ { "code": "037", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10536.0, "minimum": 10536.18, "maximum": 38810.5, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 38810.5 } ] } ] }, { "description": "HC CHROMOSOME ANALY:AMNIOTIC", "code_information": [ { "code": "88269", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 922.81, "discounted_cash": 267.0, "minimum": 173.66, "maximum": 922.81, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 922.81 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 922.81 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 922.81 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 922.81 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 922.81 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 922.81 }, { "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" } ] } ] }, { "description": "HC ELECTROLYTE PANEL", "code_information": [ { "code": "80051", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 118.13, "discounted_cash": 34.0, "minimum": 7.01, "maximum": 107.1439, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 57.89 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 70.93 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 32.77, "10th_percentile": 32.77, "90th_percentile": 32.77, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 56.75 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 70.93 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 70.93 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 64.99 }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 94.5, "10th_percentile": 94.5, "90th_percentile": 94.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 30.24, "10th_percentile": 30.24, "90th_percentile": 30.24, "count": "1 through 10" } ] } ] }, { "description": "HC CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL", "code_information": [ { "code": "70450", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1950.31, "discounted_cash": 565.0, "minimum": 565.5899, "maximum": 1768.9312, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 823.29, "10th_percentile": 198.8, "90th_percentile": 1106.31, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 529.92, "10th_percentile": 256.95, "90th_percentile": 544.77, "count": "15" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 866.97 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 510.49, "10th_percentile": 495.06, "90th_percentile": 524.8, "count": "16" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 693.58 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 866.97 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 866.97 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 1143.57, "10th_percentile": 1143.57, "90th_percentile": 1189.41, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 583.69 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 484.24, "10th_percentile": 44.42, "90th_percentile": 1366.99, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 513.9, "10th_percentile": 513.9, "90th_percentile": 513.9, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1513.25, "10th_percentile": 1427.5, "90th_percentile": 1513.25, "count": "97" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 484.24, "10th_percentile": 456.8, "90th_percentile": 484.24, "count": "74" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 1372.52, "10th_percentile": 1307.59, "90th_percentile": 1429.19, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 484.24, "10th_percentile": 456.8, "90th_percentile": 528.18, "count": "48" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 484.24, "10th_percentile": 456.8, "90th_percentile": 485.35, "count": "43" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 484.24, "10th_percentile": 484.24, "90th_percentile": 485.35, "count": "22" } ] } ] }, { "description": "HC (SUP SHELL L0220) THOR RIB BELT CUSTOM FABRICA", "code_information": [ { "code": "L0220", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 152.86, "maximum": 152.86, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 152.86, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4452) WATERPROOF TAPE - A4452 - RU270003", "code_information": [ { "code": "A4452", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "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" } ] } ] }, { "description": "HC CSF SHUNT EVALUATION", "code_information": [ { "code": "78645", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 828.44, "discounted_cash": 240.0, "minimum": 240.2476, "maximum": 828.44, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 754.21 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 828.44 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 739.33 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 828.44 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 828.44 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 828.44 } ] } ] }, { "description": "Methylprednisolone Sod Succ For Inj PF 1000 MG (Base Equiv)", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00009001820", "type": "NDC" }, { "code": "J2919", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.17, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 150.42, "10th_percentile": 46.15, "90th_percentile": 418.56, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.17 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.17 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.17 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC NM INJECT RADIOPHARM NON-IMAGING LOCALIZATION, IV", "code_information": [ { "code": "78808", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 999.69, "discounted_cash": 289.0, "minimum": 170.18, "maximum": 906.7188, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 173.61 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 212.73 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 170.18 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 212.73 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 212.73 } ] } ] }, { "description": "HC SPEECH/HEARING THERAPY INDIVIDUAL, 15 MIN", "code_information": [ { "code": "92507", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 455.31, "discounted_cash": 132.0, "minimum": 73.44, "maximum": 412.9662, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 73.44, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC MRI, CERV SPINE COMBO", "code_information": [ { "code": "72156", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3089.38, "discounted_cash": 895.0, "minimum": 895.9202, "maximum": 2802.0677, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2670.71 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2136.55 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2670.71 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2670.71 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1875.16 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 2471.5, "10th_percentile": 2471.5, "90th_percentile": 2471.5, "count": "1 through 10" } ] } ] }, { "description": "HC ASSAY OF VITAMIN K", "code_information": [ { "code": "84597", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 240.31, "discounted_cash": 69.0, "minimum": 13.72, "maximum": 217.9612, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 147.65, "10th_percentile": 147.65, "90th_percentile": 147.65, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 113.12 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 138.61 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 110.89 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 138.61 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 138.61 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 154.01, "10th_percentile": 154.01, "90th_percentile": 154.01, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 127.19 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 192.25, "10th_percentile": 192.25, "90th_percentile": 192.25, "count": "11" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 61.52, "10th_percentile": 61.52, "90th_percentile": 61.52, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 61.52, "10th_percentile": 61.52, "90th_percentile": 61.52, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 61.52, "10th_percentile": 61.52, "90th_percentile": 65.37, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL A6219) GAUZE <= 16 SQ IN W/BORDER - A6219 - RU272028", "code_information": [ { "code": "A6219", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.36, "maximum": 1.36, "payers_information": [ { "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" } ] } ] }, { "description": "HC DUPLEX SCAN EXTRACRANIAL,BILAT", "code_information": [ { "code": "93880", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1845.63, "discounted_cash": 535.0, "minimum": 535.2327, "maximum": 1673.9864, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 857.23, "10th_percentile": 857.23, "90th_percentile": 857.23, "count": "1 through 10" } ] } ] }, { "description": "HC HLA I TYPING 1 ALLELE HR", "code_information": [ { "code": "81381", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 834.06, "discounted_cash": 241.0, "minimum": 169.9, "maximum": 834.06, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 827.22 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 834.06 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 810.9 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 834.06 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 834.06 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 834.06 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 169.9, "additional_payer_notes": "100.00% 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": 4483.0, "minimum": 4483.48, "maximum": 17618.63, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17618.63 } ] } ] }, { "description": "HC X-RAY EXAM, BREAST SPECIMEN", "code_information": [ { "code": "76098", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 269.38, "discounted_cash": 78.0, "minimum": 45.76, "maximum": 244.3277, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 46.68 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 57.2 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 45.76 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 57.2 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 57.2 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 234.04 } ] } ] }, { "description": "HC (SUP SHELL A4336) URETHRAL INSERT", "code_information": [ { "code": "A4336", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2.05, "maximum": 2.05, "payers_information": [ { "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" } ] } ] }, { "description": "HC MASS SPECTROMETRY QUANT,NONSPEC", "code_information": [ { "code": "83789", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1299.69, "discounted_cash": 376.0, "minimum": 24.11, "maximum": 1178.8188, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 149.07 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 182.66 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 146.13 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 182.66 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 182.66 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 223.51 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 24.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 153.5, "10th_percentile": 153.5, "90th_percentile": 153.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 332.72, "10th_percentile": 332.72, "90th_percentile": 332.72, "count": "1 through 10" } ] } ] }, { "description": "HC DRUG SCREEN MULTIP CLASS", "code_information": [ { "code": "80307", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 323.13, "discounted_cash": 93.0, "minimum": 62.14, "maximum": 323.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 364.62, "10th_percentile": 260.62, "90th_percentile": 364.62, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 138.87, "10th_percentile": 138.87, "90th_percentile": 183.33, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 323.13 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 323.13 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 50.38, "10th_percentile": 50.38, "90th_percentile": 176.61, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 323.13 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 323.13 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 323.13 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 131.4, "10th_percentile": 131.4, "90th_percentile": 293.56, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 177.24, "10th_percentile": 177.24, "90th_percentile": 203.18, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 323.13 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 67.88, "10th_percentile": 62.14, "90th_percentile": 509.25, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 364.0, "10th_percentile": 145.25, "90th_percentile": 539.75, "count": "126" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 49.28, "10th_percentile": 46.48, "90th_percentile": 224.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 466.47, "10th_percentile": 234.46, "90th_percentile": 489.55, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 75.92, "10th_percentile": 49.28, "90th_percentile": 162.96, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 49.39, "10th_percentile": 46.48, "90th_percentile": 172.72, "count": "25" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 49.28, "10th_percentile": 49.28, "90th_percentile": 143.48, "count": "1 through 10" } ] } ] }, { "description": "HC ANGIO AORTOGRAM ABD SERIAL", "code_information": [ { "code": "75625", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10859.1, "discounted_cash": 3149.0, "minimum": 507.5461, "maximum": 9849.2037, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 868.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1063.59 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 850.87 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1063.59 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1063.59 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 507.55 } ] } ] }, { "description": "AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CCMCC", "code_information": [ { "code": "241", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8966.0, "minimum": 8966.96, "maximum": 16320.66, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16320.66 } ] } ] }, { "description": "HC THYROID UPTAKE SINGLE/MULTIPLE QUANT MEASURE", "code_information": [ { "code": "78012", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 621.88, "discounted_cash": 180.0, "minimum": 180.3452, "maximum": 611.8963, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 316.55 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 387.89 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 310.31 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 387.89 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 387.89 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 611.9 } ] } ] }, { "description": "HC MRI ABDOMEN W CONTRAST", "code_information": [ { "code": "74182", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2698.75, "discounted_cash": 782.0, "minimum": 782.6375, "maximum": 2447.7663, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2118.32 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1694.64 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2118.32 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2118.32 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1948.44 } ] } ] }, { "description": "ADRENAL AND PITUITARY PROCEDURES WITH CCMCC", "code_information": [ { "code": "614", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5380.0, "minimum": 5380.18, "maximum": 25839.09, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25839.09 } ] } ] }, { "description": "HC CT SCAN OF ABDOMEN CONTRAST", "code_information": [ { "code": "74160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3446.56, "discounted_cash": 999.0, "minimum": 650.0, "maximum": 3126.0299, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1478.35 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 855.65, "10th_percentile": 855.65, "90th_percentile": 855.65, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1182.67 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1478.35 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1478.35 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 1939.26, "10th_percentile": 1939.26, "90th_percentile": 1939.26, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1519.84 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 704.52, "10th_percentile": 704.52, "90th_percentile": 704.52, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 2467.25, "10th_percentile": 2467.25, "90th_percentile": 2467.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 789.52, "10th_percentile": 744.8, "90th_percentile": 789.52, "count": "1 through 10" } ] } ] }, { "description": "Lorazepam Inj 2 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00641604401", "type": "NDC" }, { "code": "J2060", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 4.9455, "maximum": 11.16, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 12.77, "10th_percentile": 12.77, "90th_percentile": 12.77, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.16 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.33 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.86 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 7.33 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 7.33 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.95 } ] } ] }, { "description": "HC (SUP SHELL A4331) EXTENSION DRAINAGE TUBING", "code_information": [ { "code": "A4331", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 4.53, "maximum": 4.53, "payers_information": [ { "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" } ] } ] }, { "description": "HC (SUP SHELL A2013) INNOVAMATRIX FS, PER SQ CM", "code_information": [ { "code": "A2013", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 4337.55, "maximum": 4337.55, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4337.55 } ] } ] }, { "description": "HC (SUP SHELL A6254) ABSORPT DRG <=16 SQ IN W/BDR - A6254 - 27200143", "code_information": [ { "code": "A6254", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.7, "maximum": 1.7, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1.7, "additional_payer_notes": "100.00% 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": 13450.0, "minimum": 13450.44, "maximum": 33836.73, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 33836.73 } ] } ] }, { "description": "O.R. PROCEDURES FOR OBESITY WITH CC", "code_information": [ { "code": "620", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3362.0, "minimum": 3362.61, "maximum": 18865.9, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18865.9 } ] } ] }, { "description": "HC MONONUCLEAR CELL ANTIGEN", "code_information": [ { "code": "86356", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 384.06, "discounted_cash": 111.0, "minimum": 26.78, "maximum": 348.3424, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 90.79 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 111.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 89.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 111.25 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 111.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 248.26 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 26.78, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITHOUT CCMCC", "code_information": [ { "code": "724", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4035.0, "minimum": 4035.13, "maximum": 7730.03, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7730.03 } ] } ] }, { "description": "HC RANGE OF MOTION MEASUREMENTS - 95851 - 42000051", "code_information": [ { "code": "95851", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 80.94, "discounted_cash": 23.0, "minimum": 6.47, "maximum": 80.94, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 80.94 }, { "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" } ] } ] }, { "description": "HC AMINO ACIDS, 6+ QUANT", "code_information": [ { "code": "82139", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1735.0, "discounted_cash": 503.0, "minimum": 16.87, "maximum": 1573.645, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 88.24 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 108.13 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 86.5 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 108.13 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 108.13 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 156.39 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC", "code_information": [ { "code": "306", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8518.0, "minimum": 8518.61, "maximum": 18577.07, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18577.07 } ] } ] }, { "description": "HC ASSAY OF METHADONE - G0480 - 30100205", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 194.38, "minimum": 33.0774, "maximum": 1060.8233, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 194.38 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 194.38 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 194.38 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 194.38 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 194.38 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 173.49, "10th_percentile": 173.49, "90th_percentile": 173.49, "count": "1 through 10" }, { "payer_name": "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 432.75, "10th_percentile": 164.25, "90th_percentile": 1052.5, "count": "14" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 95.76, "10th_percentile": 95.76, "90th_percentile": 95.76, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 363.48, "10th_percentile": 363.48, "90th_percentile": 375.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 132.48, "10th_percentile": 132.48, "90th_percentile": 257.04, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 132.77, "10th_percentile": 132.77, "90th_percentile": 337.54, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 55.85, "10th_percentile": 55.85, "90th_percentile": 55.85, "count": "1 through 10" } ] } ] }, { "description": "HC FIBRINOGEN, ACTIVITY", "code_information": [ { "code": "85384", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 164.69, "discounted_cash": 47.0, "minimum": 9.72, "maximum": 149.3738, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 70.1 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 85.89 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 68.72 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 85.89 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 85.89 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 90.11 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 42.16, "10th_percentile": 42.16, "90th_percentile": 42.16, "count": "1 through 10" } ] } ] }, { "description": "HC MYELIN BASIC PROTEIN,CSF", "code_information": [ { "code": "83873", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 286.88, "discounted_cash": 83.0, "minimum": 17.2, "maximum": 260.2002, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 142.01 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 174.01 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 139.2 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 174.01 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 174.01 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 159.45 }, { "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" } ] } ] }, { "description": "HC PHYSICAL PERFORMANCE TEST EA 15 MIN", "code_information": [ { "code": "97750", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 207.81, "discounted_cash": 60.0, "minimum": 32.14, "maximum": 188.4837, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 32.14, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC ARC RBC PRETREAT,SERUM DIFF RBC ABSO", "code_information": [ { "code": "86978", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 145.0, "discounted_cash": 42.0, "minimum": 42.05, "maximum": 145.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 145.0 } ] } ] }, { "description": "HC ASSAY, RBC CHOLINESTERASE", "code_information": [ { "code": "82482", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 133.75, "discounted_cash": 38.0, "minimum": 9.81, "maximum": 121.3113, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 63.43 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 77.72 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 62.18 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 77.72 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 77.72 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 90.94 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 9.81, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ORBITAL PROCEDURES WITH CCMCC", "code_information": [ { "code": "113", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10536.0, "minimum": 10536.18, "maximum": 27717.07, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27717.07 } ] } ] }, { "description": "HC CHEMOTHER, IV INFUSION, EA ADD HR", "code_information": [ { "code": "96415", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 310.94, "discounted_cash": 90.0, "minimum": 90.1726, "maximum": 282.0226, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 159.3, "10th_percentile": 154.69, "90th_percentile": 318.6, "count": "21" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 82.19, "10th_percentile": 82.19, "90th_percentile": 82.19, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 237.0, "10th_percentile": 88.78, "90th_percentile": 711.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 237.0, "10th_percentile": 237.0, "90th_percentile": 474.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 151.68, "10th_percentile": 79.6, "90th_percentile": 238.8, "count": "12" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 79.6, "10th_percentile": 17.54, "90th_percentile": 303.36, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 79.6, "10th_percentile": 75.84, "90th_percentile": 161.16, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 79.6, "10th_percentile": 75.84, "90th_percentile": 159.2, "count": "21" } ] } ] }, { "description": "O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC", "code_information": [ { "code": "940", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6949.0, "minimum": 6949.39, "maximum": 27549.67, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27549.67 } ] } ] }, { "description": "SOFT TISSUE PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "502", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5380.0, "minimum": 5380.18, "maximum": 15866.79, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15866.79 } ] } ] }, { "description": "HC ASSAY OF URINE POTASSIUM", "code_information": [ { "code": "84133", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 96.88, "discounted_cash": 28.0, "minimum": 4.73, "maximum": 87.8702, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 35.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 43.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 34.8 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 43.5 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 43.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 43.85 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.73, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Infliximab-dyyb For IV Inj 100 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00069080901", "type": "NDC" }, { "code": "Q5103", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 50.1165, "maximum": 955.08, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 955.08 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 74.74 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 59.79 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 74.74 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 74.74 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50.12 } ] } ] }, { "description": "HC DRUG SCREEN QUANT GABAPENTIN", "code_information": [ { "code": "80171", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 698.13, "discounted_cash": 202.0, "minimum": 21.67, "maximum": 633.2039, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 102.26 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 125.31 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 100.25 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 125.31 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 125.31 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 200.89 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 21.67, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L0633) LSO SC R POS/LAT PNL PRE CST", "code_information": [ { "code": "L0633", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 343.97, "maximum": 343.97, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 343.97, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC ARC COLD AGGLUTININ, TITER", "code_information": [ { "code": "86157", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 295.0, "discounted_cash": 85.0, "minimum": 8.06, "maximum": 267.565, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 66.54 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 81.53 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 65.22 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 81.53 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 81.53 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 74.72 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.06, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4391) URINARY POUCH W EX WEAR BARR", "code_information": [ { "code": "A4391", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 10.07, "maximum": 10.07, "payers_information": [ { "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" } ] } ] }, { "description": "HC PHYS THRP EVAL, MODERATE COMPLEXITY, 30 MIN", "code_information": [ { "code": "97162", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 525.94, "discounted_cash": 152.0, "minimum": 94.06, "maximum": 477.0276, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 420.75, "10th_percentile": 420.75, "90th_percentile": 420.75, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 94.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 67.68, "10th_percentile": 67.68, "90th_percentile": 67.68, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 134.64, "10th_percentile": 134.64, "90th_percentile": 134.64, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 134.64, "10th_percentile": 31.14, "90th_percentile": 134.64, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 134.64, "10th_percentile": 134.64, "90th_percentile": 134.64, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 134.64, "10th_percentile": 134.64, "90th_percentile": 134.64, "count": "1 through 10" } ] } ] }, { "description": "HC E COLI 0157 AG, EIA", "code_information": [ { "code": "87335", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 37.5, "discounted_cash": 10.0, "minimum": 10.875, "maximum": 37.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 37.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 37.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 37.5 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 37.5 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 37.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.5 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 12.66, "10th_percentile": 12.66, "90th_percentile": 12.66, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL Q4002) CAST SUP BODY CAST FIBERGLAS", "code_information": [ { "code": "Q4002", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 235.64, "maximum": 235.64, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 235.64, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "618", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9191.0, "minimum": 9191.13, "maximum": 16720.31, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16720.31 } ] } ] }, { "description": "HC ASSAY OF ASCORBIC ACID", "code_information": [ { "code": "82180", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 172.81, "discounted_cash": 50.0, "minimum": 9.89, "maximum": 156.7387, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 81.57 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 99.96 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 79.97 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 99.96 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 99.96 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 91.69 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6235) HYDROCOLLD DRG >16<=48 W/O B - A6235 - RU272051", "code_information": [ { "code": "A6235", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 23.97, "maximum": 23.97, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 23.97, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC CHORIONIC GONADOTROPIN, QUAL", "code_information": [ { "code": "84703", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 118.13, "discounted_cash": 34.0, "minimum": 7.52, "maximum": 107.1439, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 67.66, "10th_percentile": 67.66, "90th_percentile": 67.66, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 62.01 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 75.99 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 60.79 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 75.99 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 75.99 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 75.69, "10th_percentile": 75.69, "90th_percentile": 77.49, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 74.28, "10th_percentile": 74.28, "90th_percentile": 74.28, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 69.71 }, { "payer_name": "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 94.5, "10th_percentile": 94.5, "90th_percentile": 94.5, "count": "60" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 30.24, "10th_percentile": 30.24, "90th_percentile": 32.13, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 85.71, "10th_percentile": 75.53, "90th_percentile": 86.56, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL A4615) CANNULA NASAL - A4615 - 27100065", "code_information": [ { "code": "A4615", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.04, "maximum": 1.04, "payers_information": [ { "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" } ] } ] }, { "description": "HC ASSAY QUANTITATIVE,BLOOD GLUCOSE", "code_information": [ { "code": "82947", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 83.13, "discounted_cash": 24.0, "minimum": 3.93, "maximum": 75.3989, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 39.74, "10th_percentile": 39.74, "90th_percentile": 39.74, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 32.39 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 39.69 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 19.25, "10th_percentile": 19.25, "90th_percentile": 19.25, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 31.75 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 39.69 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 39.69 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.43 }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 3.93, "10th_percentile": 3.93, "90th_percentile": 3.93, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 18.87, "10th_percentile": 18.87, "90th_percentile": 18.87, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 17.76, "10th_percentile": 17.76, "90th_percentile": 17.76, "count": "1 through 10" } ] } ] }, { "description": "HC HEMATOCRIT", "code_information": [ { "code": "85014", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 43.75, "discounted_cash": 12.0, "minimum": 2.37, "maximum": 39.6812, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 12.6, "10th_percentile": 11.88, "90th_percentile": 12.6, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 19.56 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.97 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 12.14, "10th_percentile": 11.44, "90th_percentile": 12.14, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 19.17 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 23.97 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 23.97 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 21.02, "10th_percentile": 21.02, "90th_percentile": 21.02, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.97 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 35.0, "10th_percentile": 35.0, "90th_percentile": 35.0, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 33.0, "10th_percentile": 33.0, "90th_percentile": 35.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 10.56, "10th_percentile": 10.56, "90th_percentile": 11.2, "count": "17" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 26.38, "10th_percentile": 26.38, "90th_percentile": 26.38, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 11.2, "10th_percentile": 10.56, "90th_percentile": 12.21, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 11.2, "10th_percentile": 11.2, "90th_percentile": 11.2, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 11.2, "10th_percentile": 10.56, "90th_percentile": 11.22, "count": "27" } ] } ] }, { "description": "HC (SUP SHELL L1810) KO ELASTIC WITH JOINTS", "code_information": [ { "code": "L1810", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 118.79, "maximum": 118.79, "payers_information": [ { "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" } ] } ] }, { "description": "HC STOOL CULTR AEROBIC BACT EA", "code_information": [ { "code": "87046", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 32.81, "discounted_cash": 9.0, "minimum": 9.44, "maximum": 32.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 38.36, "10th_percentile": 38.36, "90th_percentile": 38.36, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 32.81 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 32.81 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 17.17, "10th_percentile": 17.17, "90th_percentile": 18.21, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 32.81 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 32.81 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 32.81 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 39.65, "10th_percentile": 39.65, "90th_percentile": 39.65, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.81 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 20.16, "10th_percentile": 20.16, "90th_percentile": 20.16, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 52.5, "10th_percentile": 49.5, "90th_percentile": 52.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 16.8, "10th_percentile": 15.84, "90th_percentile": 18.88, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 15.84, "10th_percentile": 15.84, "90th_percentile": 16.8, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 16.83, "10th_percentile": 16.8, "90th_percentile": 18.88, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 16.8, "10th_percentile": 16.8, "90th_percentile": 16.8, "count": "1 through 10" } ] } ] }, { "description": "HC ASSAY FOR PHENCYCLIDINE", "code_information": [ { "code": "83992", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 200.0, "discounted_cash": 58.0, "minimum": 58.0, "maximum": 181.4, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 121.32 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 148.65 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 118.92 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 148.65 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 148.65 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 155.74 } ] } ] }, { "description": "HC CHROMOSOME ANALYSIS:20-25", "code_information": [ { "code": "88264", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1103.75, "discounted_cash": 320.0, "minimum": 144.61, "maximum": 1103.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1028.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1103.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1008.46 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1103.75 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1103.75 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1103.75 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 144.61, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF TRANSFERRIN", "code_information": [ { "code": "84466", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 221.88, "discounted_cash": 64.0, "minimum": 12.76, "maximum": 201.2452, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 105.37 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 129.12 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 103.3 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 129.12 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 129.12 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 142.2, "10th_percentile": 142.2, "90th_percentile": 142.2, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 118.29 }, { "payer_name": "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 177.5, "10th_percentile": 177.5, "90th_percentile": 177.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 56.8, "10th_percentile": 56.8, "90th_percentile": 56.8, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 160.99, "10th_percentile": 160.99, "90th_percentile": 160.99, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 56.8, "10th_percentile": 56.8, "90th_percentile": 56.8, "count": "1 through 10" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CCMCC", "code_information": [ { "code": "282", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3810.0, "minimum": 3810.96, "maximum": 8524.61, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8524.61 } ] } ] }, { "description": "HC OVA AND PARASITES SMEARS", "code_information": [ { "code": "87177", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 177.81, "discounted_cash": 51.0, "minimum": 8.9, "maximum": 161.2737, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 73.43 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 89.98 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 46.56, "10th_percentile": 46.56, "90th_percentile": 46.56, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 71.99 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 89.98 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 89.98 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 85.52, "10th_percentile": 85.52, "90th_percentile": 85.52, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 107.55, "10th_percentile": 107.55, "90th_percentile": 107.55, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 82.51 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 142.25, "10th_percentile": 134.25, "90th_percentile": 142.25, "count": "16" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 8.9, "10th_percentile": 8.9, "90th_percentile": 45.52, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 129.02, "10th_percentile": 107.31, "90th_percentile": 129.02, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 42.96, "10th_percentile": 42.96, "90th_percentile": 45.52, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 8.9, "10th_percentile": 8.9, "90th_percentile": 8.9, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 45.52, "10th_percentile": 45.52, "90th_percentile": 45.52, "count": "1 through 10" } ] } ] }, { "description": "Vasopressin IV Soln 20 Unit/ML (For IV Infusion)", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "70121164207", "type": "NDC" }, { "code": "J2598", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 4.473, "maximum": 6.67, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.67 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.34 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 6.67 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 6.67 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.47 } ] } ] }, { "description": "FRACTURES OF FEMUR WITHOUT MCC", "code_information": [ { "code": "534", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6501.0, "minimum": 6501.05, "maximum": 9503.1, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9503.1 } ] } ] }, { "description": "Dalbavancin HCl For IV Soln 500 MG (Base Equivalent)", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "65219012012", "type": "NDC" }, { "code": "J0875", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 49.0455, "maximum": 215.46, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 215.46 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 73.14 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 58.52 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 73.14 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 73.14 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 49.05 } ] } ] }, { "description": "HC (SUP SHELL A6545) GRAD COMP NON-ELASTIC BK", "code_information": [ { "code": "A6545", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 121.41, "maximum": 121.41, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 121.41, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L0472) TLSO RIGID FRAME HYPEREX PRE", "code_information": [ { "code": "L0472", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 553.82, "maximum": 553.82, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 553.82, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MINOR BLADDER PROCEDURES WITH MCC", "code_information": [ { "code": "662", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15916.0, "minimum": 15916.35, "maximum": 36091.96, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 36091.96 } ] } ] }, { "description": "OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC", "code_information": [ { "code": "964", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8742.0, "minimum": 8742.79, "maximum": 18067.79, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18067.79 } ] } ] }, { "description": "HC VENOGRAM HEPATIC", "code_information": [ { "code": "75891", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7608.44, "discounted_cash": 2206.0, "minimum": 617.5646, "maximum": 6900.8551, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 844.66 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1035.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 827.99 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1035.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1035.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 617.56 } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY", "code_information": [ { "code": "895", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16140.0, "minimum": 16140.53, "maximum": 16866.86, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16688.48 } ] } ] }, { "description": "HC THROMBOPLAS TIME PARTIAL", "code_information": [ { "code": "85730", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 145.94, "discounted_cash": 42.0, "minimum": 6.01, "maximum": 132.3676, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 89.66, "10th_percentile": 89.66, "90th_percentile": 89.66, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 39.69, "10th_percentile": 39.69, "90th_percentile": 42.03, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 49.52 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 60.68 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 40.49, "10th_percentile": 38.24, "90th_percentile": 40.49, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 48.54 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 60.68 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 60.68 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 95.73, "10th_percentile": 95.73, "90th_percentile": 95.73, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 91.77, "10th_percentile": 88.32, "90th_percentile": 91.77, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 55.72 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 110.25, "10th_percentile": 110.25, "90th_percentile": 110.25, "count": "1 through 10" }, { "payer_name": "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 116.75, "10th_percentile": 110.25, "90th_percentile": 116.75, "count": "49" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 37.36, "10th_percentile": 6.01, "90th_percentile": 37.49, "count": "17" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 105.89, "10th_percentile": 88.12, "90th_percentile": 106.94, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 37.36, "10th_percentile": 37.36, "90th_percentile": 40.79, "count": "33" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 37.36, "10th_percentile": 35.28, "90th_percentile": 74.72, "count": "19" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 37.36, "10th_percentile": 35.28, "90th_percentile": 37.49, "count": "13" } ] } ] }, { "description": "HC NM IMAGING, WHOLE BODY, SINGLE DAY", "code_information": [ { "code": "78802", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6793.44, "discounted_cash": 1970.0, "minimum": 1079.7, "maximum": 6161.6501, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1079.7 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1349.63 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1349.63 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2072.53 }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1101.43 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1349.63 } ] } ] }, { "description": "Potassium Chloride Inj 2 mEq/ML", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "63323096503", "type": "NDC" }, { "code": "J3480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.76, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 62.35, "10th_percentile": 62.35, "90th_percentile": 62.35, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.76 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC GLYCOSYLATED HEMOGLOBIN TEST", "code_information": [ { "code": "83036", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 176.88, "discounted_cash": 51.0, "minimum": 9.71, "maximum": 160.4302, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 101.31, "10th_percentile": 101.31, "90th_percentile": 101.31, "count": "32" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 50.94, "10th_percentile": 50.94, "90th_percentile": 50.94, "count": "114" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 98.16 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 49.07, "10th_percentile": 49.07, "90th_percentile": 49.07, "count": "118" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 78.52 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 98.16 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 98.16 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 90.14, "10th_percentile": 90.14, "90th_percentile": 90.14, "count": "53" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 111.22, "10th_percentile": 111.22, "90th_percentile": 113.36, "count": "55" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 90.02 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 113.38, "10th_percentile": 23.52, "90th_percentile": 141.5, "count": "202" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 32.89, "10th_percentile": 32.41, "90th_percentile": 32.89, "count": "1 through 10" }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 141.5, "10th_percentile": 141.5, "90th_percentile": 141.5, "count": "431" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 45.28, "10th_percentile": 45.28, "90th_percentile": 45.28, "count": "329" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 128.34, "10th_percentile": 113.1, "90th_percentile": 129.61, "count": "51" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 45.28, "10th_percentile": 45.28, "90th_percentile": 52.36, "count": "307" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 48.11, "10th_percentile": 9.71, "90th_percentile": 48.11, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 45.28, "10th_percentile": 45.28, "90th_percentile": 48.11, "count": "152" } ] } ] }, { "description": "Metoclopramide HCl Inj 5 MG/ML (Base Equivalent)", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "00409341421", "type": "NDC" }, { "code": "J2765", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 3.5595, "maximum": 12.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 19.35, "10th_percentile": 12.77, "90th_percentile": 19.35, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.31 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.25 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 5.31 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 5.31 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.56 } ] } ] }, { "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": 204.0, "minimum": 107.26, "maximum": 640.0064, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 381.27, "10th_percentile": 381.27, "90th_percentile": 433.54, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 203.22, "10th_percentile": 191.7, "90th_percentile": 203.22, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 109.41 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 134.07 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 184.67, "10th_percentile": 184.67, "90th_percentile": 195.77, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 107.26 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 134.07 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 134.07 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 359.59, "10th_percentile": 359.59, "90th_percentile": 359.59, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 248.17 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 181.05, "10th_percentile": 9.76, "90th_percentile": 181.05, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 564.5, "10th_percentile": 532.5, "90th_percentile": 564.5, "count": "43" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 180.64, "10th_percentile": 170.4, "90th_percentile": 180.64, "count": "25" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 512.0, "10th_percentile": 451.2, "90th_percentile": 512.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 180.64, "10th_percentile": 170.4, "90th_percentile": 180.64, "count": "20" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 180.64, "10th_percentile": 170.4, "90th_percentile": 181.05, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 180.64, "10th_percentile": 170.4, "90th_percentile": 180.64, "count": "1 through 10" } ] } ] }, { "description": "HC STOOL CULTURE,SALMONELLA & SHIGELLA", "code_information": [ { "code": "87045", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 254.06, "discounted_cash": 73.0, "minimum": 9.44, "maximum": 230.4324, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 148.61, "10th_percentile": 148.61, "90th_percentile": 148.61, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 77.84 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 95.38 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 66.5, "10th_percentile": 66.5, "90th_percentile": 70.49, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 76.31 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 95.38 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 95.38 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 153.61, "10th_percentile": 153.61, "90th_percentile": 153.61, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 87.51 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 203.25, "10th_percentile": 191.75, "90th_percentile": 203.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 9.44, "10th_percentile": 9.44, "90th_percentile": 65.04, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 61.36, "10th_percentile": 61.36, "90th_percentile": 65.04, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 9.44, "10th_percentile": 9.44, "90th_percentile": 65.2, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 65.04, "10th_percentile": 65.04, "90th_percentile": 65.04, "count": "1 through 10" } ] } ] }, { "description": "HC WBC ANTIBODY IDENTIFICATION", "code_information": [ { "code": "86021", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 66.25, "discounted_cash": 19.0, "minimum": 15.05, "maximum": 66.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 38.75, "10th_percentile": 38.75, "90th_percentile": 38.75, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 66.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 66.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 66.25 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 66.25 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 66.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 66.25 }, { "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 Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 16.0, "10th_percentile": 16.0, "90th_percentile": 16.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 48.07, "10th_percentile": 48.07, "90th_percentile": 48.07, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 16.96, "10th_percentile": 16.96, "90th_percentile": 16.96, "count": "1 through 10" } ] } ] }, { "description": "HC ULTRASOUND ELASTOGRAPHY PARENCHYMA", "code_information": [ { "code": "76981", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 677.5, "discounted_cash": 196.0, "minimum": 196.475, "maximum": 645.7009, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 645.7 } ] } ] }, { "description": "HC INTRINSIC FACTOR ANTIBODY", "code_information": [ { "code": "86340", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 284.69, "discounted_cash": 82.0, "minimum": 15.08, "maximum": 258.2138, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 124.42 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 152.46 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 121.97 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 152.46 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 152.46 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 139.8 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 214.75, "10th_percentile": 214.75, "90th_percentile": 214.75, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 72.88, "10th_percentile": 72.88, "90th_percentile": 72.88, "count": "1 through 10" } ] } ] }, { "description": "HC ASSAY OF BLOOD LIPOPROTEIN,LDL CHOLEST", "code_information": [ { "code": "83721", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 128.75, "discounted_cash": 37.0, "minimum": 10.5, "maximum": 116.7763, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 88.61, "10th_percentile": 88.61, "90th_percentile": 88.61, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 44.55, "10th_percentile": 44.55, "90th_percentile": 44.55, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 75.7 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 92.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 74.2 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 92.75 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 92.75 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 78.83, "10th_percentile": 65.61, "90th_percentile": 78.83, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 82.51, "10th_percentile": 82.51, "90th_percentile": 97.27, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 97.34 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 123.75, "10th_percentile": 103.0, "90th_percentile": 123.75, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 32.96, "10th_percentile": 32.96, "90th_percentile": 39.6, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 39.6, "10th_percentile": 38.11, "90th_percentile": 45.79, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 35.02, "10th_percentile": 35.02, "90th_percentile": 39.6, "count": "1 through 10" } ] } ] }, { "description": "HC CARCINOEMBRYONIC ANTIGEN", "code_information": [ { "code": "82378", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 296.25, "discounted_cash": 85.0, "minimum": 18.96, "maximum": 268.6988, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 156.59 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 191.88 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 82.19, "10th_percentile": 82.19, "90th_percentile": 82.19, "count": "11" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 153.5 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 191.88 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 191.88 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 175.77 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 176.17, "10th_percentile": 74.26, "90th_percentile": 237.0, "count": "12" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 237.0, "10th_percentile": 237.0, "90th_percentile": 237.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 75.84, "10th_percentile": 75.84, "90th_percentile": 75.84, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 75.84, "10th_percentile": 75.84, "90th_percentile": 214.96, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 75.84, "10th_percentile": 75.84, "90th_percentile": 75.84, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 75.84, "10th_percentile": 75.84, "90th_percentile": 80.58, "count": "1 through 10" } ] } ] }, { "description": "Acetazolamide Sodium For Inj 500 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "67457085350", "type": "NDC" }, { "code": "J1120", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 60.039, "maximum": 222.97, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 222.97 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 89.54 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 71.63 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 89.54 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 89.54 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 60.04 } ] } ] }, { "description": "BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC", "code_information": [ { "code": "462", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4931.0, "minimum": 4931.83, "maximum": 31358.69, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 31358.69 } ] } ] }, { "description": "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": 30.0, "minimum": 20.4, "maximum": 95.0, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "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" } ] } ] }, { "description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC", "code_information": [ { "code": "560", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8518.0, "minimum": 8518.61, "maximum": 30676.9725, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "other", "standard_charge_dollar": 8901.96, "standard_charge_algorithm": "2342.62 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 6467.57, "10th_percentile": 6467.57, "90th_percentile": 10979.72, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 8518.61, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 17549.28, "10th_percentile": 5849.76, "90th_percentile": 40948.32, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "other", "standard_charge_dollar": 8518.61, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 54285.76, "10th_percentile": 41344.96, "90th_percentile": 70615.1, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13275.57 } ] } ] }, { "description": "HC ECHO HEART XTHORACIC,COMPLETE W DOPPLER", "code_information": [ { "code": "93306", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3168.75, "discounted_cash": 918.0, "minimum": 918.9375, "maximum": 2874.0563, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 706.66, "10th_percentile": 706.66, "90th_percentile": 1108.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 912.6, "10th_percentile": 912.6, "90th_percentile": 912.6, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 1623.41, "10th_percentile": 1623.41, "90th_percentile": 1654.59, "count": "27" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 879.14, "10th_percentile": 879.14, "90th_percentile": 879.14, "count": "15" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.1, "median_amount": 2030.54, "10th_percentile": 2030.54, "90th_percentile": 2078.7, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 1992.51, "10th_percentile": 1992.51, "90th_percentile": 1992.51, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 884.13, "10th_percentile": 409.64, "90th_percentile": 934.83, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 2535.0, "10th_percentile": 2535.0, "90th_percentile": 2535.0, "count": "30" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 811.2, "10th_percentile": 811.2, "90th_percentile": 861.9, "count": "29" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 2299.25, "10th_percentile": 2299.25, "90th_percentile": 2299.25, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 187.59, "10th_percentile": 162.24, "90th_percentile": 1012.57, "count": "25" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 811.2, "10th_percentile": 811.2, "90th_percentile": 861.9, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 811.2, "10th_percentile": 811.2, "90th_percentile": 861.9, "count": "18" } ] } ] }, { "description": "HC NM THERAPY, ORAL", "code_information": [ { "code": "79005", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 596.88, "discounted_cash": 173.0, "minimum": 173.0952, "maximum": 541.3702, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 248.81 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 311.01 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 311.01 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 434.27 }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 253.82 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 311.01 } ] } ] }, { "description": "HC HEART INFARCT IMAGE", "code_information": [ { "code": "78466", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 792.5, "discounted_cash": 229.0, "minimum": 229.825, "maximum": 792.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 570.41 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 698.95 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 559.16 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 698.95 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 698.95 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 792.5 } ] } ] }, { "description": "HC RUSSELL VIPER VENOM, DILUTED", "code_information": [ { "code": "85613", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 117.5, "discounted_cash": 34.0, "minimum": 9.58, "maximum": 106.5725, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 49.52 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 60.68 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 32.6, "10th_percentile": 32.6, "90th_percentile": 32.6, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 48.54 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 60.68 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 60.68 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 88.81 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 9.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 88.75, "10th_percentile": 88.75, "90th_percentile": 213.25, "count": "1 through 10" } ] } ] }, { "description": "HC PSYCH DIAGNOSTIC EVALUATION", "code_information": [ { "code": "90791", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 548.75, "discounted_cash": 159.0, "minimum": 159.1375, "maximum": 497.7163, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 258.01, "10th_percentile": 258.01, "90th_percentile": 258.01, "count": "31" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 373.96, "10th_percentile": 373.96, "90th_percentile": 373.96, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 330.39, "10th_percentile": 330.39, "90th_percentile": 330.39, "count": "1 through 10" } ] } ] }, { "description": "Enoxaparin Sodium Inj Soln Pref Syr 100 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "71288043691", "type": "NDC" }, { "code": "J1650", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.638, "maximum": 12.8, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.8 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2.44 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.95 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2.44 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2.44 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.64 } ] } ] }, { "description": "HC X-RAY SINUSES <3 VW", "code_information": [ { "code": "70210", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 467.81, "discounted_cash": 135.0, "minimum": 82.95, "maximum": 424.3037, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 84.62 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 103.69 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 82.95 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 103.69 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 103.69 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 203.03 } ] } ] }, { "description": "HC VENOGRAM EXTREM UNILAT", "code_information": [ { "code": "75820", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3313.44, "discounted_cash": 960.0, "minimum": 324.62, "maximum": 3005.2901, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 331.16 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 405.78 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 324.62 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 405.78 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 405.78 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 501.95 } ] } ] }, { "description": "HC US BREAST UNILAT LIMITED", "code_information": [ { "code": "76642", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 612.19, "discounted_cash": 177.0, "minimum": 177.5351, "maximum": 555.2563, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 330.79, "10th_percentile": 330.79, "90th_percentile": 376.13, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 176.31, "10th_percentile": 166.32, "90th_percentile": 176.31, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 275.28 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 169.85, "10th_percentile": 160.22, "90th_percentile": 169.85, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 220.22 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 275.28 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 275.28 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 311.97, "10th_percentile": 311.97, "90th_percentile": 311.97, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 384.94, "10th_percentile": 370.11, "90th_percentile": 384.94, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 448.34 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 156.72, "10th_percentile": 156.72, "90th_percentile": 157.08, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 489.75, "10th_percentile": 462.0, "90th_percentile": 697.5, "count": "24" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 156.72, "10th_percentile": 147.84, "90th_percentile": 157.08, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 170.94, "10th_percentile": 170.94, "90th_percentile": 444.2, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 156.72, "10th_percentile": 147.84, "90th_percentile": 223.2, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 156.72, "10th_percentile": 156.72, "90th_percentile": 223.2, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 156.72, "10th_percentile": 156.72, "90th_percentile": 156.72, "count": "1 through 10" } ] } ] }, { "description": "Pegfilgrastim Soln Prefilled Syringe 6 MG/0.6ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "55513019001", "type": "NDC" }, { "code": "J2506", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 62.937, "maximum": 93.86, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 93.86 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 75.09 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 93.86 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 93.86 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 62.94 } ] } ] }, { "description": "HC CLOT INHIB PROTEIN S,FREE", "code_information": [ { "code": "85306", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 620.63, "discounted_cash": 179.0, "minimum": 15.32, "maximum": 562.9114, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 117.98 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 144.57 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 115.65 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 144.57 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 144.57 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 142.02 }, { "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" } ] } ] }, { "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": 508.0, "minimum": 508.1351, "maximum": 1589.2363, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 714.81 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 875.9 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 700.71 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 875.9 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 875.9 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1497.3 } ] } ] }, { "description": "PERIPHERAL VASCULAR DISORDERS WITH CC", "code_information": [ { "code": "300", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6949.0, "minimum": 6949.39, "maximum": 13194.1476, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "other", "standard_charge_dollar": 7262.12, "standard_charge_algorithm": "2342.62 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 10185.96, "10th_percentile": 10185.96, "90th_percentile": 10185.96, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12584.74 } ] } ] }, { "description": "SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS", "code_information": [ { "code": "019", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22641.0, "minimum": 22641.57, "maximum": 84109.66, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 84109.66 } ] } ] }, { "description": "MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CCMCC", "code_information": [ { "code": "829", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13226.0, "minimum": 13226.27, "maximum": 37253.18, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 37253.18 } ] } ] }, { "description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC", "code_information": [ { "code": "026", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6276.0, "minimum": 6276.87, "maximum": 36654.3, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 36654.3 } ] } ] }, { "description": "HC (SUP SHELL A7525) TRACHEOSTOMY MASK - A7525 - 27100034", "code_information": [ { "code": "A7525", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2.94, "maximum": 2.94, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2.94, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Ertapenem Sodium For Inj 1 GM (Base Equivalent)", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "44567082001", "type": "NDC" }, { "code": "J1335", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 28.917, "maximum": 922.76, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 922.76 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 43.13 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 34.5 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 43.13 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 43.13 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.92 } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC", "code_information": [ { "code": "897", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7397.0, "minimum": 7397.74, "maximum": 10407.31, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "other", "standard_charge_dollar": 7730.65, "standard_charge_algorithm": "2342.62 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 7756.07, "10th_percentile": 4282.63, "90th_percentile": 14860.78, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "other", "standard_charge_dollar": 7397.74, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 12300.0, "10th_percentile": 12300.0, "90th_percentile": 12300.0, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10407.31 } ] } ] }, { "description": "HC ASSAY OF INTERLEUKIN-6 (IL-6)", "code_information": [ { "code": "83529", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 325.0, "discounted_cash": 94.0, "minimum": 17.27, "maximum": 294.775, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.1 }, { "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" } ] } ] }, { "description": "HC FETAL BLEED SCREEN, ROSETTE", "code_information": [ { "code": "85461", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 288.44, "discounted_cash": 83.0, "minimum": 9.36, "maximum": 261.6151, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 54.78 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 67.12 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 53.7 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 67.12 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 67.12 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 86.77 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 9.36, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC ANTINUCLEAR ANTIBODIES TITER", "code_information": [ { "code": "86039", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 46.25, "discounted_cash": 13.0, "minimum": 11.16, "maximum": 46.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 28.42, "10th_percentile": 28.42, "90th_percentile": 28.42, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 46.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 46.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 12.83, "10th_percentile": 12.83, "90th_percentile": 12.83, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 46.25 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 46.25 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 46.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 46.25 }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 37.0, "10th_percentile": 35.0, "90th_percentile": 37.0, "count": "19" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 11.2, "10th_percentile": 11.2, "90th_percentile": 11.84, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 11.84, "10th_percentile": 11.2, "90th_percentile": 11.84, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL A7524) TRACHEOSTOMA STENT/STUD/BTTN", "code_information": [ { "code": "A7524", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 110.33, "maximum": 110.33, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 110.33, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A7521) TRACH/LARYN TUBE CUFFED", "code_information": [ { "code": "A7521", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 67.04, "maximum": 67.04, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 67.04, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hydromorphone HCl Inj 2 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00641615101", "type": "NDC" }, { "code": "J1171", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 12.77, "10th_percentile": 12.77, "90th_percentile": 25.55, "count": "34" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "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": 90.0, "median_amount": 6.25, "10th_percentile": 6.25, "90th_percentile": 6.25, "count": "1 through 10" } ] } ] }, { "description": "UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CCMCC", "code_information": [ { "code": "742", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6052.0, "minimum": 6052.7, "maximum": 21630.42, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21630.42 } ] } ] }, { "description": "URETHRAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "672", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3586.0, "minimum": 3586.78, "maximum": 12726.2, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12726.2 } ] } ] }, { "description": "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": 1.89, "maximum": 16.45, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.45 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2.82 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2.25 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2.82 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2.82 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.89 } ] } ] }, { "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": 46.0, "minimum": 46.4, "maximum": 160.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.0 } ] } ] }, { "description": "OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH CC", "code_information": [ { "code": "674", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12329.0, "minimum": 12329.57, "maximum": 27569.71, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27569.71 } ] } ] }, { "description": "OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC", "code_information": [ { "code": "698", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10760.0, "minimum": 10760.35, "maximum": 19503.69, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19503.69 } ] } ] }, { "description": "HC BRAF GENE", "code_information": [ { "code": "81210", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1315.0, "discounted_cash": 381.0, "minimum": 175.4, "maximum": 1315.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 451.29 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 552.98 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 442.39 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 552.98 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 552.98 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1315.0 }, { "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" } ] } ] }, { "description": "Diphenhydramine HCl Liquid 12.5 MG/5ML", "drug_information": { "unit": 118.0, "type": "ML" }, "code_information": [ { "code": "00904698520", "type": "NDC" }, { "code": "Q0163", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 3.99, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC", "code_information": [ { "code": "167", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7621.0, "minimum": 7621.92, "maximum": 21260.25, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21260.25 } ] } ] }, { "description": "HC ASSAY OF CERULOPLASMIN", "code_information": [ { "code": "82390", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 158.44, "discounted_cash": 45.0, "minimum": 10.74, "maximum": 143.7051, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 88.64 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 108.62 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 86.89 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 108.62 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 108.62 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 101.54, "10th_percentile": 101.54, "90th_percentile": 101.54, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 99.57 }, { "payer_name": "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 126.75, "10th_percentile": 126.75, "90th_percentile": 126.75, "count": "1 through 10" } ] } ] }, { "description": "Acetylcysteine Inhal Soln 10%", "drug_information": { "unit": 4.0, "type": "ML" }, "code_information": [ { "code": "63323069504", "type": "NDC" }, { "code": "J7608", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 26.586, "maximum": 64.37, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 64.37 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 39.65 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 31.72 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 39.65 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 39.65 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.59 } ] } ] }, { "description": "HC (SUP SHELL A6531) COMPRESSION STOCKING BK30-40", "code_information": [ { "code": "A6531", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 61.66, "maximum": 61.66, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 61.66, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CCMCC", "code_information": [ { "code": "903", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5828.0, "minimum": 5828.52, "maximum": 13788.39, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13788.39 } ] } ] }, { "description": "URETHRAL STRICTURE", "code_information": [ { "code": "697", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5828.0, "minimum": 5828.52, "maximum": 12706.16, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12706.16 } ] } ] }, { "description": "HC (SUP SHELL L8420) PROSTHETIC SOCK MULTI PLY BK", "code_information": [ { "code": "L8420", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 25.45, "maximum": 25.45, "payers_information": [ { "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" } ] } ] }, { "description": "HC XR FLUORO GUIDANCE CV/PICC LINE", "code_information": [ { "code": "77001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 730.0, "discounted_cash": 211.0, "minimum": 211.7, "maximum": 685.1736, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 342.85 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 420.1 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 336.08 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 420.1 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 420.1 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 685.17 } ] } ] }, { "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": 6.615, "maximum": 47.31, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 47.31 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.87 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7.89 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 9.87 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 9.87 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.62 } ] } ] }, { "description": "HC FETAL BLEED SCREEN, KLEIHAUER-BETKE", "code_information": [ { "code": "85460", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 394.06, "discounted_cash": 114.0, "minimum": 7.73, "maximum": 357.4124, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 63.88 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 78.28 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 62.62 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 78.28 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 78.28 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 71.66 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7.73, "additional_payer_notes": "100.00% 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", "minimum": 1.36, "maximum": 1.36, "payers_information": [ { "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" } ] } ] }, { "description": "HC ARTHROGRAM OF WRIST", "code_information": [ { "code": "73115", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1090.63, "discounted_cash": 316.0, "minimum": 291.71, "maximum": 989.2014, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 297.58 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 364.64 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 291.71 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 364.64 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 364.64 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 916.41 } ] } ] }, { "description": "Azithromycin Tab 250 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "50268007411", "type": "NDC" }, { "code": "Q0144", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 79.3485, "maximum": 363.9, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 363.9 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 118.34 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 94.67 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 118.34 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 118.34 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 79.35 } ] } ] }, { "description": "HC (SUP SHELL A6212) FOAM DRG <=16 SQ IN W/BORDER - A6212 - 27100084", "code_information": [ { "code": "A6212", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 13.84, "maximum": 13.84, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "LIMB REATTACHMENT, HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA", "code_information": [ { "code": "956", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13226.0, "minimum": 13226.27, "maximum": 44361.93, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 44361.93 } ] } ] }, { "description": "HC (SUP SHELL A6224) GAUZE > 48 IN NO W/SAL W/O B - A6224 - 27100088", "code_information": [ { "code": "A6224", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 5.13, "maximum": 5.13, "payers_information": [ { "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" } ] } ] }, { "description": "HC BARTONELLA, ANTIBODY", "code_information": [ { "code": "86611", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 72.19, "discounted_cash": 20.0, "minimum": 10.18, "maximum": 72.19, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 72.19 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 72.19 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 72.19 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 72.19 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 72.19 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 73.26, "10th_percentile": 73.26, "90th_percentile": 73.26, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 72.19 }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 115.0, "10th_percentile": 115.0, "90th_percentile": 184.25, "count": "1 through 10" } ] } ] }, { "description": "HC ANGIO PELVIS", "code_information": [ { "code": "75736", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8203.44, "discounted_cash": 2378.0, "minimum": 781.0556, "maximum": 7440.5201, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 924.91 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1133.33 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 906.66 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1133.33 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1133.33 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 781.06 } ] } ] }, { "description": "HC PROTEIN TOT REFRACTOMETRY ANY SRC", "code_information": [ { "code": "84160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 94.38, "discounted_cash": 27.0, "minimum": 5.61, "maximum": 85.6027, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 22.91, "10th_percentile": 22.91, "90th_percentile": 22.91, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 11.52, "10th_percentile": 11.52, "90th_percentile": 11.52, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 42.74 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 52.37 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 11.1, "10th_percentile": 11.1, "90th_percentile": 32.0, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 41.89 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 52.37 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 52.37 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 52.01 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 32.0, "10th_percentile": 32.0, "90th_percentile": 32.0, "count": "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 32.0, "10th_percentile": 32.0, "90th_percentile": 32.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 10.24, "10th_percentile": 5.61, "90th_percentile": 10.24, "count": "19" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 11.84, "10th_percentile": 11.84, "90th_percentile": 29.02, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 10.24, "10th_percentile": 10.24, "90th_percentile": 11.84, "count": "27" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 10.24, "10th_percentile": 10.24, "90th_percentile": 10.24, "count": "11" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 10.24, "10th_percentile": 10.24, "90th_percentile": 10.24, "count": "1 through 10" } ] } ] }, { "description": "PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC", "code_information": [ { "code": "543", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7846.0, "minimum": 7846.09, "maximum": 12119.07, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12119.07 } ] } ] }, { "description": "HC (SUP SHELL A4461) SURGICL DRESS HOLD NON-REUSE - A4461 - 27100058", "code_information": [ { "code": "A4461", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 4.7, "maximum": 4.7, "payers_information": [ { "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" } ] } ] }, { "description": "Glycopyrrolate Inj 0.4 MG/2ML (0.2 MG/ML)", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "71288041402", "type": "NDC" }, { "code": "J1596", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.6065, "maximum": 2.4, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2.4 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.92 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2.4 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2.4 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.61 } ] } ] }, { "description": "HC VENOGRAM INFER VENA CAVA", "code_information": [ { "code": "75825", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8263.75, "discounted_cash": 2396.0, "minimum": 521.6826, "maximum": 7495.2212, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 831.55 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1018.94 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 815.15 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1018.94 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1018.94 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 521.68 } ] } ] }, { "description": "INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC", "code_information": [ { "code": "351", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6501.0, "minimum": 6501.05, "maximum": 17972.3, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17972.3 } ] } ] }, { "description": "HC CT ANGIO, ABD, COMBO,INCL IMAGE PROC", "code_information": [ { "code": "74175", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2355.0, "discounted_cash": 682.0, "minimum": 650.0, "maximum": 2135.985, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 678.24, "10th_percentile": 678.24, "90th_percentile": 678.24, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1744.7 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 653.37, "10th_percentile": 653.37, "90th_percentile": 653.37, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1395.75 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1744.7 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1744.7 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1937.17 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 206.72, "10th_percentile": 206.72, "90th_percentile": 206.72, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1884.0, "10th_percentile": 1777.25, "90th_percentile": 1884.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 657.58, "10th_percentile": 657.58, "90th_percentile": 657.58, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 602.88, "10th_percentile": 602.88, "90th_percentile": 602.88, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 602.88, "10th_percentile": 602.88, "90th_percentile": 602.88, "count": "1 through 10" } ] } ] }, { "description": "HC CYTOPATH, CELL ENHANCE TECH", "code_information": [ { "code": "88112", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 169.38, "discounted_cash": 49.0, "minimum": 49.1202, "maximum": 169.38, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 169.38 } ] } ] }, { "description": "SEPTIC ARTHRITIS WITH CC", "code_information": [ { "code": "549", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8742.0, "minimum": 8742.79, "maximum": 67148.928, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "other", "standard_charge_dollar": 9136.22, "standard_charge_algorithm": "2342.62 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 33807.6, "10th_percentile": 33807.6, "90th_percentile": 33807.6, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14231.66 } ] } ] }, { "description": "HC ED LEVEL 5", "code_information": [ { "code": "99285", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3182.19, "discounted_cash": 922.0, "minimum": 922.8351, "maximum": 3182.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 1585.05, "10th_percentile": 674.92, "90th_percentile": 1585.05, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 916.47, "10th_percentile": 796.95, "90th_percentile": 916.47, "count": "35" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 2699.23 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 3182.19 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 882.87, "10th_percentile": 767.73, "90th_percentile": 882.87, "count": "48" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2646.01 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.1, "median_amount": 1815.28, "10th_percentile": 1815.28, "90th_percentile": 1815.28, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 2000.96, "10th_percentile": 1773.44, "90th_percentile": 2000.96, "count": "13" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 79.93, "median_amount": 1769.45, "10th_percentile": 1769.45, "90th_percentile": 2698.64, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 1426.99, "10th_percentile": 548.79, "90th_percentile": 2545.75, "count": "112" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 1031.26, "10th_percentile": 1031.26, "90th_percentile": 1031.26, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 2545.75, "10th_percentile": 2213.75, "90th_percentile": 2545.75, "count": "374" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 814.64, "10th_percentile": 708.4, "90th_percentile": 814.64, "count": "120" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 2027.8, "10th_percentile": 1769.45, "90th_percentile": 2331.91, "count": "19" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 814.64, "10th_percentile": 110.0, "90th_percentile": 814.64, "count": "126" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 814.64, "10th_percentile": 708.4, "90th_percentile": 814.64, "count": "96" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 814.64, "10th_percentile": 708.4, "90th_percentile": 814.64, "count": "47" } ] } ] }, { "description": "HC NM BONE MARROW IMAGING LTD AREA", "code_information": [ { "code": "78102", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 817.81, "discounted_cash": 237.0, "minimum": 237.1649, "maximum": 817.81, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 526.65 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 645.32 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 516.26 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 645.32 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 645.32 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 817.81 } ] } ] }, { "description": "Ampicillin Sodium For Inj 250 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00781340278", "type": "NDC" }, { "code": "J0290", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.89, "maximum": 16.45, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.45 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2.82 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2.25 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2.82 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2.82 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.89 } ] } ] }, { "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": 70.0, "minimum": 29.81, "maximum": 219.9475, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 30.41 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 37.27 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 29.81 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 37.27 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 37.27 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 58.87 } ] } ] }, { "description": "HC (SUP SHELL L0130) FLEX THERMOPLASTIC COLLAR MO", "code_information": [ { "code": "L0130", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 195.66, "maximum": 195.66, "payers_information": [ { "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" } ] } ] }, { "description": "HC (SUP SHELL L2830) SOFT INTERFACE ABOVE KNEE SE", "code_information": [ { "code": "L2830", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 143.94, "maximum": 143.94, "payers_information": [ { "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" } ] } ] }, { "description": "SPINAL DISORDERS AND INJURIES WITH CCMCC", "code_information": [ { "code": "052", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9191.0, "minimum": 9191.13, "maximum": 21353.38, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21353.38 } ] } ] }, { "description": "HC MOG-IGG1 ANTB CBA EACH", "code_information": [ { "code": "86362", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2515.0, "discounted_cash": 729.0, "minimum": 12.05, "maximum": 2281.105, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 111.71 }, { "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" } ] } ] }, { "description": "HC HEPATITIS B SURFACE AG, EIA", "code_information": [ { "code": "87340", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 136.56, "discounted_cash": 39.0, "minimum": 10.33, "maximum": 123.8599, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 74.59, "10th_percentile": 68.92, "90th_percentile": 83.9, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 39.33, "10th_percentile": 39.33, "90th_percentile": 39.33, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 85.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 104.46 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 33.38, "10th_percentile": 33.38, "90th_percentile": 33.38, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 83.57 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 104.46 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 104.46 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 69.59, "10th_percentile": 61.31, "90th_percentile": 78.93, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 77.11, "10th_percentile": 77.11, "90th_percentile": 85.87, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.76 }, { "payer_name": "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 109.25, "10th_percentile": 96.25, "90th_percentile": 109.25, "count": "71" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 30.8, "10th_percentile": 30.8, "90th_percentile": 34.96, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 99.09, "10th_percentile": 88.17, "90th_percentile": 99.09, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 34.96, "10th_percentile": 30.8, "90th_percentile": 34.96, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 34.96, "10th_percentile": 34.96, "90th_percentile": 34.96, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 32.73, "10th_percentile": 30.8, "90th_percentile": 34.96, "count": "1 through 10" } ] } ] }, { "description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC", "code_information": [ { "code": "516", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8966.0, "minimum": 8966.96, "maximum": 24498.68, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24498.68 } ] } ] }, { "description": "ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC", "code_information": [ { "code": "266", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5604.0, "minimum": 5604.35, "maximum": 72247.59, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 72247.59 } ] } ] }, { "description": "OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC", "code_information": [ { "code": "314", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10760.0, "minimum": 10349.0556, "maximum": 24582.38, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24582.38 } ] } ] }, { "description": "HC ASSAY OF VITAMIN B-2", "code_information": [ { "code": "84252", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 469.38, "discounted_cash": 136.0, "minimum": 20.24, "maximum": 425.7277, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 167.05 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 204.69 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 163.75 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 204.69 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 204.69 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 187.63 }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 375.5, "10th_percentile": 375.5, "90th_percentile": 375.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 120.16, "10th_percentile": 120.16, "90th_percentile": 120.16, "count": "1 through 10" } ] } ] }, { "description": "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", "minimum": 25.326, "maximum": 79.09, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 79.09 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 37.77 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 30.22 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 37.77 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 37.77 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.33 } ] } ] }, { "description": "HC (SUP SHELL A4330) STOOL COLLECTION POUCH - A4330 - 27100005", "code_information": [ { "code": "A4330", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 10.21, "maximum": 10.21, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 10.21, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY ORBITS", "code_information": [ { "code": "70200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 734.06, "discounted_cash": 212.0, "minimum": 117.25, "maximum": 665.7924, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 119.61 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 146.56 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 117.25 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 146.56 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 146.56 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 293.25 } ] } ] }, { "description": "Fosaprepitant Dimeglumine For IV Infusion 150 MG (Base Eq)", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "31722016531", "type": "NDC" }, { "code": "J1453", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 30.56, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 30.56 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "Phenylephrine HCl Inj 10 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "70069080125", "type": "NDC" }, { "code": "J2371", "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 TISSUE CULTURE, BONE MARROW", "code_information": [ { "code": "88237", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 841.25, "discounted_cash": 243.0, "minimum": 143.75, "maximum": 841.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 329.8 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 404.12 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 323.3 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 404.12 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 404.12 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 841.25 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 143.75, "additional_payer_notes": "100.00% 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": 139.0, "minimum": 45.81, "maximum": 436.2126, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "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" } ] } ] }, { "description": "HC HEMOGLOBIN ELECTROPHORESIS", "code_information": [ { "code": "83020", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 233.13, "discounted_cash": 67.0, "minimum": 12.87, "maximum": 211.4489, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 130.23 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 104.18 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 130.23 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 130.23 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 119.31 }, { "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" } ] } ] }, { "description": "OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT", "code_information": [ { "code": "124", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7173.0, "minimum": 7173.57, "maximum": 15598.0, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15598.0 } ] } ] }, { "description": "HC BODY FLUID CELL COUNT W DIFF", "code_information": [ { "code": "89051", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 159.06, "discounted_cash": 46.0, "minimum": 5.6, "maximum": 144.2674, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 45.45 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 55.69 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 44.14, "10th_percentile": 44.14, "90th_percentile": 44.14, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 44.55 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 55.69 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 55.69 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 51.91 }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 120.0, "10th_percentile": 120.0, "90th_percentile": 120.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 40.72, "10th_percentile": 40.72, "90th_percentile": 40.72, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 115.42, "10th_percentile": 115.42, "90th_percentile": 115.42, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 40.72, "10th_percentile": 40.72, "90th_percentile": 40.72, "count": "1 through 10" } ] } ] }, { "description": "MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC", "code_information": [ { "code": "371", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11657.0, "minimum": 11657.05, "maximum": 25106.0549, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20903.04 } ] } ] }, { "description": "HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC", "code_information": [ { "code": "480", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13674.0, "minimum": 13674.61, "maximum": 34333.05, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34333.05 } ] } ] }, { "description": "HC CHEST X-RAY 2 VW", "code_information": [ { "code": "71046", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 319.06, "discounted_cash": 92.0, "minimum": 78.51, "maximum": 289.3874, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 182.76, "10th_percentile": 182.76, "90th_percentile": 197.82, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 80.09 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 98.14 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 78.51 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 98.14 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 98.14 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 197.36 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 55.3, "10th_percentile": 55.3, "90th_percentile": 55.3, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 231.51, "10th_percentile": 231.51, "90th_percentile": 233.81, "count": "1 through 10" } ] } ] }, { "description": "HC EHRLICHIA, ANTIBODY", "code_information": [ { "code": "86666", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 217.81, "discounted_cash": 63.0, "minimum": 10.18, "maximum": 197.5537, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 80.56 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 98.71 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 78.97 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 98.71 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 98.71 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 94.37 }, { "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" } ] } ] }, { "description": "HC CRYPTOSPOR AG, EIA", "code_information": [ { "code": "87328", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 193.44, "discounted_cash": 56.0, "minimum": 13.82, "maximum": 175.4501, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 94.58 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 115.89 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 92.71 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 115.89 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 115.89 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 128.12 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 13.82, "10th_percentile": 13.82, "90th_percentile": 13.82, "count": "1 through 10" } ] } ] }, { "description": "HC ASSAY OF ETHYLENE GLYCOL", "code_information": [ { "code": "82693", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1101.88, "discounted_cash": 319.0, "minimum": 14.9, "maximum": 999.4052, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 122.95 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 150.66 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 120.53 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 150.66 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 150.66 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 138.13 }, { "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" } ] } ] }, { "description": "HC (SUP SHELL A4322) IRRIGATION SYRINGE", "code_information": [ { "code": "A4322", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 4.35, "maximum": 4.35, "payers_information": [ { "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" } ] } ] }, { "description": "Folic Acid Inj 5 MG/ML", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "63323018410", "type": "NDC" }, { "code": "J1808", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC ASSAY OF URINE VMA", "code_information": [ { "code": "84585", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 268.75, "discounted_cash": 77.0, "minimum": 15.5, "maximum": 243.7562, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 127.99 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 156.83 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 125.46 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 156.83 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 156.83 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 143.69 }, { "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" } ] } ] }, { "description": "SIMPLE PNEUMONIA AND PLEURISY WITHOUT CCMCC", "code_information": [ { "code": "195", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4931.0, "minimum": 4931.83, "maximum": 14211.765, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 4931.83, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 15006.74, "10th_percentile": 15006.74, "90th_percentile": 15599.36, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7409.37 } ] } ] }, { "description": "HC MRI LOWER EXTREM W/CONTRAST", "code_information": [ { "code": "73719", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2698.75, "discounted_cash": 782.0, "minimum": 782.6375, "maximum": 2447.7663, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2118.32 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1694.64 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2118.32 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2118.32 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1649.59 } ] } ] }, { "description": "HC ASSAY OF TOTAL TESTOSTERONE", "code_information": [ { "code": "84403", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 347.19, "discounted_cash": 100.0, "minimum": 25.81, "maximum": 314.9013, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 237.89, "10th_percentile": 237.89, "90th_percentile": 237.89, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 99.99, "10th_percentile": 99.99, "90th_percentile": 99.99, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 213.12 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 261.15 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 96.33, "10th_percentile": 96.33, "90th_percentile": 96.33, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 208.92 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 261.15 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 261.15 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 176.93, "10th_percentile": 176.93, "90th_percentile": 176.93, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 222.51, "10th_percentile": 218.31, "90th_percentile": 222.51, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 239.27 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 274.05, "10th_percentile": 136.22, "90th_percentile": 277.75, "count": "1 through 10" }, { "payer_name": "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 277.75, "10th_percentile": 277.75, "90th_percentile": 277.75, "count": "35" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 88.88, "10th_percentile": 88.88, "90th_percentile": 94.44, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 251.92, "10th_percentile": 251.92, "90th_percentile": 254.42, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 88.88, "10th_percentile": 88.88, "90th_percentile": 102.77, "count": "18" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 88.88, "10th_percentile": 88.88, "90th_percentile": 94.44, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 88.88, "10th_percentile": 88.88, "90th_percentile": 88.88, "count": "1 through 10" } ] } ] }, { "description": "HC X-RAY FOOT 3+ VW", "code_information": [ { "code": "73630", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 490.63, "discounted_cash": 142.0, "minimum": 84.38, "maximum": 445.0014, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 265.1, "10th_percentile": 265.1, "90th_percentile": 265.1, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 141.3, "10th_percentile": 133.29, "90th_percentile": 141.3, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 86.08 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 105.47 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 136.12, "10th_percentile": 136.12, "90th_percentile": 136.12, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 84.38 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 105.47 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 105.47 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 303.6, "10th_percentile": 250.02, "90th_percentile": 314.39, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 308.51, "10th_percentile": 296.61, "90th_percentile": 308.51, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 222.77 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 125.89, "10th_percentile": 125.6, "90th_percentile": 392.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 392.5, "10th_percentile": 370.25, "90th_percentile": 392.5, "count": "91" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 125.6, "10th_percentile": 118.48, "90th_percentile": 125.6, "count": "28" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 356.0, "10th_percentile": 313.73, "90th_percentile": 356.0, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 125.6, "10th_percentile": 118.48, "90th_percentile": 136.99, "count": "23" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 125.6, "10th_percentile": 125.6, "90th_percentile": 125.89, "count": "11" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 125.6, "10th_percentile": 118.48, "90th_percentile": 125.89, "count": "17" } ] } ] }, { "description": "PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITH MCC OR 4+ ARTERIESINTRALUMINAL DEVICES", "code_information": [ { "code": "321", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8294.0, "minimum": 8294.44, "maximum": 32075.46, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 32075.46 } ] } ] }, { "description": "TRANSURETHRAL PROSTATECTOMY WITHOUT CCMCC", "code_information": [ { "code": "714", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3362.0, "minimum": 3362.61, "maximum": 12465.67, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12465.67 } ] } ] }, { "description": "HC (SUP SHELL A6257) TRANSPARENT FILM <= 16 SQ IN - A6257 - 27200146", "code_information": [ { "code": "A6257", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2.18, "maximum": 2.18, "payers_information": [ { "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" } ] } ] }, { "description": "Fluconazole in NaCl 0.9% Inj 200 MG/100ML", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "00338604648", "type": "NDC" }, { "code": "J1450", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 11.277, "maximum": 65.98, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 65.98 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.82 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13.45 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 16.82 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 16.82 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.28 } ] } ] }, { "description": "THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "627", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 2914.0, "minimum": 2914.26, "maximum": 15659.3, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15659.3 } ] } ] }, { "description": "HIV WITH MAJOR RELATED CONDITION WITH MCC", "code_information": [ { "code": "974", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14795.0, "minimum": 14795.48, "maximum": 34023.0, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34023.0 } ] } ] }, { "description": "HC APPLY MULTLAY COMPRS LWR LEG", "code_information": [ { "code": "29581", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 602.5, "discounted_cash": 174.0, "minimum": 174.725, "maximum": 546.4675, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 74.25, "10th_percentile": 52.02, "90th_percentile": 77.94, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 75.54, "10th_percentile": 72.64, "90th_percentile": 75.54, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 137.5, "10th_percentile": 137.5, "90th_percentile": 137.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 66.0, "10th_percentile": 66.0, "90th_percentile": 69.28, "count": "19" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 9.25, "10th_percentile": 9.25, "90th_percentile": 9.25, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 46.24, "10th_percentile": 46.24, "90th_percentile": 46.24, "count": "1 through 10" } ] } ] }, { "description": "HC AMINO ACIDS, SINGLE QUANTITATION", "code_information": [ { "code": "82131", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 240.31, "discounted_cash": 69.0, "minimum": 22.98, "maximum": 217.9612, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 139.24 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 170.61 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 136.49 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 170.61 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 170.61 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 213.04 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH MCC", "code_information": [ { "code": "319", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16588.0, "minimum": 16588.88, "maximum": 52613.04, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 52613.04 } ] } ] }, { "description": "HC MRI LOWER EXTR W/O CONTRAST F/U BY CONTRAST", "code_information": [ { "code": "73720", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3281.25, "discounted_cash": 951.0, "minimum": 900.0, "maximum": 2976.0938, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2670.71 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2136.55 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2670.71 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2670.71 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2083.79 } ] } ] }, { "description": "HC (SUP SHELL A4424) OST PCH DRAIN W BAR & FILTER - A4424 - RU272037", "code_information": [ { "code": "A4424", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 6.78, "maximum": 6.78, "payers_information": [ { "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" } ] } ] }, { "description": "HC HEPARIN NEUTRALIZATION", "code_information": [ { "code": "85525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 191.56, "discounted_cash": 55.0, "minimum": 11.84, "maximum": 173.7449, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 97.8 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 119.84 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 95.87 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 119.84 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 119.84 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 109.76 }, { "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" } ] } ] }, { "description": "EXTRAOCULAR PROCEDURES EXCEPT ORBIT", "code_information": [ { "code": "115", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8518.0, "minimum": 8518.61, "maximum": 18094.91, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18094.91 } ] } ] }, { "description": "HC PERQ BREAST LOC DEV PLACE MRI GUIDE ADDL LESION", "code_information": [ { "code": "19288", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2553.13, "discounted_cash": 740.0, "minimum": 740.4077, "maximum": 2315.6889, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 } ] } ] }, { "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": 763.0, "minimum": 650.0, "maximum": 2386.5437, "payers_information": [ { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1744.7 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 1654.53, "10th_percentile": 1654.53, "90th_percentile": 1654.53, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1722.87 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 443.59, "10th_percentile": 443.59, "90th_percentile": 588.6, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 2105.0, "10th_percentile": 1985.75, "90th_percentile": 2105.0, "count": "40" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 673.6, "10th_percentile": 635.44, "90th_percentile": 675.16, "count": "17" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 1909.24, "10th_percentile": 734.73, "90th_percentile": 1909.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 673.6, "10th_percentile": 635.44, "90th_percentile": 673.6, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 673.6, "10th_percentile": 673.6, "90th_percentile": 675.16, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 675.16, "10th_percentile": 673.6, "90th_percentile": 675.16, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 1421.8, "10th_percentile": 1421.8, "90th_percentile": 1421.8, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 378.9, "10th_percentile": 357.44, "90th_percentile": 757.8, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1744.7 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 730.01, "10th_percentile": 688.66, "90th_percentile": 730.01, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1395.75 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1744.7 } ] } ] }, { "description": "HC NM PARATHYROID PLANAR IMAGING", "code_information": [ { "code": "78070", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 842.19, "discounted_cash": 244.0, "minimum": 244.2351, "maximum": 842.19, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 519.32 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 636.35 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 509.08 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 636.35 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 636.35 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 842.19 } ] } ] }, { "description": "HC (SUP SHELL C9361) NEUROMEND NERVE WRAP", "code_information": [ { "code": "C9361", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 558.369, "maximum": 558.369, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 558.37 } ] } ] }, { "description": "HC HEPATITIS B SURFACE AB TEST", "code_information": [ { "code": "86706", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 136.56, "discounted_cash": 39.0, "minimum": 10.74, "maximum": 123.8599, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 73.75, "10th_percentile": 73.75, "90th_percentile": 73.75, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 86.32 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 105.78 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 84.62 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 105.78 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 105.78 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 69.59, "10th_percentile": 69.59, "90th_percentile": 69.59, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 82.51, "10th_percentile": 82.51, "90th_percentile": 82.51, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 99.57 }, { "payer_name": "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 103.0, "10th_percentile": 103.0, "90th_percentile": 109.25, "count": "36" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 99.09, "10th_percentile": 99.09, "90th_percentile": 99.09, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 32.96, "10th_percentile": 32.96, "90th_percentile": 32.96, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 34.96, "10th_percentile": 34.96, "90th_percentile": 34.96, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 34.96, "10th_percentile": 34.96, "90th_percentile": 34.96, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL Q4042) CAST SUP LNG LEG SPLNT FBRGL", "code_information": [ { "code": "Q4042", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 43.49, "maximum": 43.49, "payers_information": [ { "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" } ] } ] }, { "description": "HC (SUP SHELL A4208) 3 CC STERILE SYRINGE&NEEDLE", "code_information": [ { "code": "A4208", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.08, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.08 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.08 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.08 } ] } ] }, { "description": "HC (SUP SHELL L3929) HFO NONTORSION JNTS PRE CST", "code_information": [ { "code": "L3929", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 87.9, "maximum": 87.9, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 87.9, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC MRI, LOWER EXTREM", "code_information": [ { "code": "73718", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2488.44, "discounted_cash": 721.0, "minimum": 721.6476, "maximum": 2257.0151, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1725.03 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1380.01 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1725.03 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1725.03 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1409.89 } ] } ] }, { "description": "HC PHYS THRP EVAL, LOW COMPLEXITY, 20 MIN", "code_information": [ { "code": "97161", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 525.94, "discounted_cash": 152.0, "minimum": 94.05, "maximum": 477.0276, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 151.47, "10th_percentile": 151.47, "90th_percentile": 151.47, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 94.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 67.68, "10th_percentile": 67.68, "90th_percentile": 67.68, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 134.64, "10th_percentile": 134.64, "90th_percentile": 134.64, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 134.64, "10th_percentile": 134.64, "90th_percentile": 134.64, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL Q4225) AMNIO OR DERMA TL, PER SQ CM", "code_information": [ { "code": "Q4225", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 4369.3335, "maximum": 6856.67, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6856.67 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5485.28 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 6856.67 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 6856.67 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4369.33 } ] } ] }, { "description": "HC ASSAY ALKALINE PHOSPHATASE", "code_information": [ { "code": "84075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 83.13, "discounted_cash": 24.0, "minimum": 5.18, "maximum": 75.3989, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 23.94, "10th_percentile": 23.94, "90th_percentile": 23.94, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 42.74 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 52.37 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 23.06, "10th_percentile": 23.06, "90th_percentile": 23.06, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 41.89 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 52.37 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 52.37 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 42.36, "10th_percentile": 42.36, "90th_percentile": 42.36, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 48.02 }, { "payer_name": "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 66.5, "10th_percentile": 48.75, "90th_percentile": 66.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 21.28, "10th_percentile": 21.28, "90th_percentile": 21.28, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 21.28, "10th_percentile": 21.28, "90th_percentile": 21.28, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 21.28, "10th_percentile": 21.28, "90th_percentile": 22.61, "count": "1 through 10" } ] } ] }, { "description": "HC X-RAY KNEE 4+ VIEW", "code_information": [ { "code": "73564", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 630.94, "discounted_cash": 182.0, "minimum": 110.11, "maximum": 572.2626, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 341.0, "10th_percentile": 341.0, "90th_percentile": 341.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 171.45, "10th_percentile": 171.45, "90th_percentile": 171.45, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 112.33 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 137.64 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 175.05, "10th_percentile": 165.17, "90th_percentile": 175.05, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 110.11 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 137.64 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 137.64 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 321.53, "10th_percentile": 321.53, "90th_percentile": 321.53, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 307.38 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 271.92, "10th_percentile": 161.52, "90th_percentile": 319.79, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 504.75, "10th_percentile": 476.25, "90th_percentile": 504.75, "count": "26" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 161.52, "10th_percentile": 152.4, "90th_percentile": 161.93, "count": "15" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 436.25, "10th_percentile": 436.25, "90th_percentile": 436.25, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 161.52, "10th_percentile": 30.48, "90th_percentile": 242.76, "count": "15" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 161.52, "10th_percentile": 152.4, "90th_percentile": 161.93, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 161.52, "10th_percentile": 152.4, "90th_percentile": 161.52, "count": "1 through 10" } ] } ] }, { "description": "MEDICAL BACK PROBLEMS WITHOUT MCC", "code_information": [ { "code": "552", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6501.0, "minimum": 6501.05, "maximum": 19165.32, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11332.75 } ] } ] }, { "description": "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 (SUP SHELL A5056) 1 PC OST POUCH W FILTER", "code_information": [ { "code": "A5056", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 6.66, "maximum": 6.66, "payers_information": [ { "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" } ] } ] }, { "description": "HC (SUP SHELL A4624) TRACHEAL SUCTION TUBE - A4624 - 27200092", "code_information": [ { "code": "A4624", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 3.2, "maximum": 3.2, "payers_information": [ { "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" } ] } ] }, { "description": "Pegfilgrastim Soln Prefill Syr/Infusion Dev 6 MG/0.6ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "55513019201", "type": "NDC" }, { "code": "J2506", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 62.937, "maximum": 93.86, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 93.86 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 75.09 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 93.86 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 93.86 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 62.94 } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC", "code_information": [ { "code": "288", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16813.0, "minimum": 16813.05, "maximum": 89728.698, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "other", "standard_charge_dollar": 17569.65, "standard_charge_algorithm": "2342.62 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 15017.92, "10th_percentile": 15017.92, "90th_percentile": 15017.92, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 31903.34 } ] } ] }, { "description": "HC (SUP SHELL A6257) TRANSPARENT FILM <= 16 SQ IN - A6257 - RU272058", "code_information": [ { "code": "A6257", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2.18, "maximum": 2.18, "payers_information": [ { "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" } ] } ] }, { "description": "KCl 40 MEQ/L (0.3%) in NaCl 0.9% Inj", "drug_information": { "unit": 1000.0, "type": "ML" }, "code_information": [ { "code": "00338069504", "type": "NDC" }, { "code": "J3480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.76, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 62.35, "10th_percentile": 62.35, "90th_percentile": 62.35, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.76 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC X-RAY PELVIS 1/2 VW", "code_information": [ { "code": "72170", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 724.69, "discounted_cash": 210.0, "minimum": 67.21, "maximum": 657.2938, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 127.8, "10th_percentile": 127.8, "90th_percentile": 127.8, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 68.56 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 84.01 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 246.23, "10th_percentile": 246.23, "90th_percentile": 246.23, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 67.21 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 84.01 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 84.01 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 166.36 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 282.74, "10th_percentile": 282.74, "90th_percentile": 282.74, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 355.0, "10th_percentile": 335.0, "90th_percentile": 579.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 107.2, "10th_percentile": 107.2, "90th_percentile": 113.6, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 306.86, "10th_percentile": 306.86, "90th_percentile": 306.86, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 113.6, "10th_percentile": 113.6, "90th_percentile": 113.6, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 113.6, "10th_percentile": 113.6, "90th_percentile": 113.6, "count": "1 through 10" } ] } ] }, { "description": "OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "356", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17037.0, "minimum": 17037.22, "maximum": 51786.63, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 51786.63 } ] } ] }, { "description": "HC NM BRAIN FLOW IMAGING ONLY", "code_information": [ { "code": "78610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1752.19, "discounted_cash": 508.0, "minimum": 508.1351, "maximum": 1589.2363, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 628.74 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 770.42 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 616.34 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 770.42 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 770.42 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1254.8 } ] } ] }, { "description": "HC NM LIVER AND SPLEEN IMAGING", "code_information": [ { "code": "78215", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 984.06, "discounted_cash": 285.0, "minimum": 285.3774, "maximum": 984.06, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 631.69 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 774.04 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 619.23 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 774.04 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 774.04 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 984.06 } ] } ] }, { "description": "HC (SUP SHELL A4216) STERILE WATER/SALINE, 10 ML", "code_information": [ { "code": "A4216", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 6.2, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.2 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.96 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 6.2 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 6.2 }, { "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" } ] } ] }, { "description": "HC UGT1A1 GENE ANALYSIS COMMON VARIANTS", "code_information": [ { "code": "81350", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 825.63, "discounted_cash": 239.0, "minimum": 224.16, "maximum": 825.63, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 228.67 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 280.2 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 224.16 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 280.2 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 280.2 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 825.63 }, { "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" } ] } ] }, { "description": "HC (SUP SHELL Q4187) EPICORD 1 SQ CM", "code_information": [ { "code": "Q4187", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 778.113, "maximum": 1160.45, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1160.45 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 928.35 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1160.45 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1160.45 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 778.11 } ] } ] }, { "description": "HC TUMOR IMAGING, MULT AREAS", "code_information": [ { "code": "78801", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2228.44, "discounted_cash": 646.0, "minimum": 646.2476, "maximum": 2021.1951, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 812.58 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 995.69 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 796.55 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 995.69 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 995.69 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1824.42 } ] } ] }, { "description": "HC MICROSLIDE CONSULT W SLIDE PREP", "code_information": [ { "code": "88323", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1474.38, "discounted_cash": 427.0, "minimum": 340.6909, "maximum": 1337.2627, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 340.69 } ] } ] }, { "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": "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" } ] } ] }, { "description": "HC FETAL BIOPHYS PROF,W/O NST", "code_information": [ { "code": "76819", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 780.0, "discounted_cash": 226.0, "minimum": 218.79, "maximum": 707.46, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 223.2 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 273.49 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 218.79 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 273.49 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 273.49 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 420.13 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 624.0, "10th_percentile": 624.0, "90th_percentile": 624.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 565.97, "10th_percentile": 565.97, "90th_percentile": 565.97, "count": "1 through 10" } ] } ] }, { "description": "HC WORK HARDENING INIT 2 HR", "code_information": [ { "code": "97545", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 565.63, "discounted_cash": 164.0, "minimum": 95.0, "maximum": 513.0264, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "HC CHROMOSOME ANAL:15-20,2 KARYOTYPES", "code_information": [ { "code": "88262", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 965.31, "discounted_cash": 279.0, "minimum": 125.49, "maximum": 965.31, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 965.31 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 965.31 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 965.31 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 965.31 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 965.31 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 965.31 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 125.49, "additional_payer_notes": "100.00% 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": 12777.0, "minimum": 12777.92, "maximum": 29954.62, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 29954.62 } ] } ] }, { "description": "HC (SUP SHELL A7002) TUBING USED W SUCTION PUMP", "code_information": [ { "code": "A7002", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 5.31, "maximum": 5.31, "payers_information": [ { "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" } ] } ] }, { "description": "OTHER VASCULAR PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "254", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4035.0, "minimum": 4035.13, "maximum": 21004.43, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21004.43 } ] } ] }, { "description": "HC ASSAY OF C-PEPTIDE", "code_information": [ { "code": "84681", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 411.88, "discounted_cash": 119.0, "minimum": 20.81, "maximum": 373.5752, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 118.62, "10th_percentile": 118.62, "90th_percentile": 118.62, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 171.74 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 210.44 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 168.35 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 210.44 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 210.44 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 192.92 }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 329.5, "10th_percentile": 329.5, "90th_percentile": 329.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 105.44, "10th_percentile": 105.44, "90th_percentile": 112.03, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 105.44, "10th_percentile": 105.44, "90th_percentile": 121.92, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 105.44, "10th_percentile": 105.44, "90th_percentile": 105.44, "count": "1 through 10" } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITH CC", "code_information": [ { "code": "289", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11657.0, "minimum": 11657.05, "maximum": 20122.61, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20122.61 } ] } ] }, { "description": "HC HLA TYPING, A,B,OR C /SINGLE", "code_information": [ { "code": "86812", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 340.94, "discounted_cash": 98.0, "minimum": 25.81, "maximum": 309.2326, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 209.47, "10th_percentile": 209.47, "90th_percentile": 209.47, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 213.01 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 261.01 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 208.81 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 261.01 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 261.01 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 163.87, "10th_percentile": 163.87, "90th_percentile": 163.87, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 239.27 }, { "payer_name": "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 257.25, "10th_percentile": 257.25, "90th_percentile": 272.75, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 247.38, "10th_percentile": 247.38, "90th_percentile": 247.38, "count": "1 through 10" } ] } ] }, { "description": "HC IV INFU, THERAP/PROPH/DIAGN, ADD INF, 1ST HR", "code_information": [ { "code": "96367", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 320.31, "discounted_cash": 92.0, "minimum": 92.8899, "maximum": 290.5212, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 164.1, "10th_percentile": 164.1, "90th_percentile": 492.31, "count": "28" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 88.87, "10th_percentile": 88.87, "90th_percentile": 177.74, "count": "13" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 256.25, "10th_percentile": 256.25, "90th_percentile": 256.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 256.25, "10th_percentile": 256.25, "90th_percentile": 512.5, "count": "31" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 82.0, "10th_percentile": 82.0, "90th_percentile": 87.13, "count": "12" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 94.81, "10th_percentile": 82.0, "90th_percentile": 164.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 82.0, "10th_percentile": 82.0, "90th_percentile": 246.0, "count": "15" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 87.13, "10th_percentile": 82.0, "90th_percentile": 174.25, "count": "1 through 10" } ] } ] }, { "description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC", "code_information": [ { "code": "025", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14347.0, "minimum": 14347.14, "maximum": 53600.96, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 53600.96 } ] } ] }, { "description": "INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC", "code_information": [ { "code": "727", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10087.0, "minimum": 10087.83, "maximum": 36560.016, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17481.88 } ] } ] }, { "description": "HC CT SCAN ABDOMEN/PELVIS W CONTRAST", "code_information": [ { "code": "74177", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3459.06, "discounted_cash": 1003.0, "minimum": 650.0, "maximum": 3137.3674, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 1696.74, "10th_percentile": 1696.74, "90th_percentile": 1696.74, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 853.11, "10th_percentile": 853.11, "90th_percentile": 904.32, "count": "19" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1322.81 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 871.16, "10th_percentile": 821.83, "90th_percentile": 871.16, "count": "39" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1058.25 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1322.81 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1322.81 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 1974.43, "10th_percentile": 1898.41, "90th_percentile": 1974.43, "count": "13" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1914.63 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 805.72, "10th_percentile": 673.32, "90th_percentile": 1529.16, "count": "16" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 544.25, "10th_percentile": 544.25, "90th_percentile": 544.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 2512.0, "10th_percentile": 2369.75, "90th_percentile": 2512.0, "count": "198" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 803.84, "10th_percentile": 758.32, "90th_percentile": 805.72, "count": "114" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 2170.69, "10th_percentile": 2007.84, "90th_percentile": 2278.38, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 803.84, "10th_percentile": 758.32, "90th_percentile": 876.81, "count": "68" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 803.84, "10th_percentile": 803.84, "90th_percentile": 805.72, "count": "61" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 803.84, "10th_percentile": 758.32, "90th_percentile": 805.72, "count": "37" } ] } ] }, { "description": "OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITHOUT CCMCC", "code_information": [ { "code": "845", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5380.0, "minimum": 5380.18, "maximum": 10039.5, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10039.5 } ] } ] }, { "description": "HC (SUP SHELL Q4180) REVITA, PER SQ CM", "code_information": [ { "code": "Q4180", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2030.23, "maximum": 4839.39, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2030.23 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4839.39 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3871.47 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 4839.39 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 4839.39 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3244.94 } ] } ] }, { "description": "HC ASSAY OF VITAMIN B-6", "code_information": [ { "code": "84207", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 643.75, "discounted_cash": 186.0, "minimum": 28.1, "maximum": 583.8813, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 224.26 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 274.79 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 219.84 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 274.79 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 274.79 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 404.79, "10th_percentile": 404.79, "90th_percentile": 404.79, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 260.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 346.74, "10th_percentile": 346.74, "90th_percentile": 346.74, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 119.71, "10th_percentile": 119.71, "90th_percentile": 119.71, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 28.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 515.0, "10th_percentile": 515.0, "90th_percentile": 515.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 164.8, "10th_percentile": 164.8, "90th_percentile": 164.8, "count": "1 through 10" } ] } ] }, { "description": "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": 1.638, "maximum": 12.8, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.8 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2.44 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.95 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2.44 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2.44 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.64 } ] } ] }, { "description": "Cefazolin Sodium For Inj 2 GM", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "60505623100", "type": "NDC" }, { "code": "J0690", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2.6145, "maximum": 11.46, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.46 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.9 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3.12 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 3.9 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 3.9 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2.61 } ] } ] }, { "description": "HC (SUP SHELL A6550) NEG PRES WOUND THER DRSG SET", "code_information": [ { "code": "A6550", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 31.67, "maximum": 31.67, "payers_information": [ { "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" } ] } ] }, { "description": "HC X-RAY ELBOW 3+ VW", "code_information": [ { "code": "73080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 533.44, "discounted_cash": 154.0, "minimum": 100.12, "maximum": 483.8301, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 144.9, "10th_percentile": 144.9, "90th_percentile": 153.63, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 102.13 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 125.15 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 148.0, "10th_percentile": 139.59, "90th_percentile": 148.0, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 100.12 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 125.15 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 125.15 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 271.84, "10th_percentile": 271.84, "90th_percentile": 341.83, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 208.63 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 426.75, "10th_percentile": 402.5, "90th_percentile": 426.75, "count": "32" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 136.56, "10th_percentile": 136.56, "90th_percentile": 136.85, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 387.06, "10th_percentile": 387.06, "90th_percentile": 387.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 136.56, "10th_percentile": 128.8, "90th_percentile": 148.93, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 136.56, "10th_percentile": 136.56, "90th_percentile": 136.56, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 136.56, "10th_percentile": 136.56, "90th_percentile": 136.56, "count": "1 through 10" } ] } ] }, { "description": "Multiple Level Spinal Fusion Except Cervical without MCC", "code_information": [ { "code": "448", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7397.0, "minimum": 7397.74, "maximum": 49994.71, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 49994.71 } ] } ] }, { "description": "HC (SUP SHELL L3908) WHO COCK-UP NONMOLDE PRE OTS", "code_information": [ { "code": "L3908", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 89.82, "maximum": 89.82, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 89.82, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC", "code_information": [ { "code": "344", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15468.0, "minimum": 15468.01, "maximum": 30448.58, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30448.58 } ] } ] }, { "description": "HC ALLERGEN SPEC IGE QUANT,EACH", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 60.31, "discounted_cash": 17.0, "minimum": 5.22, "maximum": 54.7012, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 1105.34, "10th_percentile": 1105.34, "90th_percentile": 1105.34, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 43.08 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 52.78 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 42.23 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 52.78 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 52.78 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 153.68, "10th_percentile": 153.68, "90th_percentile": 153.68, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 48.39 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 779.75, "10th_percentile": 48.25, "90th_percentile": 1439.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 450.88, "10th_percentile": 450.88, "90th_percentile": 479.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 460.56, "10th_percentile": 460.56, "90th_percentile": 521.33, "count": "1 through 10" } ] } ] }, { "description": "HC MACROSCOPIC EXAM, PARASITE", "code_information": [ { "code": "87169", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 95.63, "discounted_cash": 27.0, "minimum": 4.31, "maximum": 86.7364, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 35.22 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 43.16 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 34.52 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 43.16 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 43.16 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.96 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 76.5, "10th_percentile": 76.5, "90th_percentile": 76.5, "count": "1 through 10" } ] } ] }, { "description": "HC ASSAY OF TOPIRAMATE", "code_information": [ { "code": "80201", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 210.31, "discounted_cash": 60.0, "minimum": 11.92, "maximum": 190.7512, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 98.36 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 120.53 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 96.42 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 120.53 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 120.53 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 110.5 }, { "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" } ] } ] }, { "description": "Levetiracetam in Sodium Chloride IV Soln 1000 MG/100ML", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "43598063652", "type": "NDC" }, { "code": "J1953", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.76, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.76 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "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": 130.0, "minimum": 38.5, "maximum": 406.7351, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 317.7 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 389.3 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 311.44 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 389.3 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 389.3 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 356.91 }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 358.75, "10th_percentile": 358.75, "90th_percentile": 358.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 38.5, "10th_percentile": 38.5, "90th_percentile": 38.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 114.8, "10th_percentile": 114.8, "90th_percentile": 114.8, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 114.8, "10th_percentile": 114.8, "90th_percentile": 114.8, "count": "1 through 10" } ] } ] }, { "description": "LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CCMCC", "code_information": [ { "code": "497", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3138.0, "minimum": 3138.44, "maximum": 14244.62, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14244.62 } ] } ] }, { "description": "HC 3D RENDERING W/INTERP & POSTPROCESS SUPERVISION (76376)", "code_information": [ { "code": "76376", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1009.06, "discounted_cash": 292.0, "minimum": 132.5548, "maximum": 915.2174, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 280.11 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 343.23 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 274.58 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 343.23 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 343.23 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 132.55 } ] } ] }, { "description": "HC (SUP SHELL L8690) AUD OSSEO DEV, INT/EXT COMP", "code_information": [ { "code": "L8690", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 5717.38, "maximum": 5717.38, "payers_information": [ { "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" } ] } ] }, { "description": "MAJOR BLADDER PROCEDURES WITH MCC", "code_information": [ { "code": "653", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21296.0, "minimum": 21296.53, "maximum": 61260.26, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 61260.26 } ] } ] }, { "description": "HC (SUP SHELL L0150) CERV SEMI-RIG ADJ MOLDED CHN", "code_information": [ { "code": "L0150", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 141.67, "maximum": 141.67, "payers_information": [ { "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" } ] } ] }, { "description": "Fulvestrant Inj Soln Pref Syr 250 MG/5ML", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "25021047174", "type": "NDC" }, { "code": "J9395", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 21.735, "maximum": 1429.24, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1429.24 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 32.37 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 25.89 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 32.37 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 32.37 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.74 } ] } ] }, { "description": "HC (SUP SHELL L2755) CARBON GRAPHITE LAMINATION", "code_information": [ { "code": "L2755", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 156.68, "maximum": 156.68, "payers_information": [ { "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" } ] } ] }, { "description": "HC ANGIO AORTOGRAM THOR SERIAL", "code_information": [ { "code": "75605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8332.81, "discounted_cash": 2416.0, "minimum": 578.0235, "maximum": 7557.8587, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 876.77 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1074.35 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 859.48 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1074.35 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1074.35 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 578.02 } ] } ] }, { "description": "MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC", "code_information": [ { "code": "808", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11657.0, "minimum": 11657.05, "maximum": 26028.89, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26028.89 } ] } ] }, { "description": "MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "826", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18830.0, "minimum": 18830.62, "maximum": 55146.49, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 55146.49 } ] } ] }, { "description": "HC (SUP SHELL Q4258) ENVERSE, PER SQ CM", "code_information": [ { "code": "Q4258", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 226.233, "maximum": 337.35, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 337.35 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 269.88 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 337.35 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 337.35 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 226.23 } ] } ] }, { "description": "O.R. PROCEDURES FOR OBESITY WITHOUT CCMCC", "code_information": [ { "code": "621", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 2690.0, "minimum": 2690.09, "maximum": 17782.5, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17782.5 } ] } ] }, { "description": "HC MRI, CERV SPINE", "code_information": [ { "code": "72141", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2406.88, "discounted_cash": 697.0, "minimum": 697.9952, "maximum": 2183.0402, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 1478.78, "10th_percentile": 1478.78, "90th_percentile": 1478.78, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 693.18, "10th_percentile": 693.18, "90th_percentile": 693.18, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1725.03 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 667.76, "10th_percentile": 667.76, "90th_percentile": 667.76, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1380.01 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1725.03 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1725.03 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 1542.52, "10th_percentile": 1542.52, "90th_percentile": 1542.52, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1071.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 616.16, "10th_percentile": 616.16, "90th_percentile": 616.16, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1925.5, "10th_percentile": 1925.5, "90th_percentile": 1925.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 616.16, "10th_percentile": 616.16, "90th_percentile": 616.16, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 1746.43, "10th_percentile": 1746.43, "90th_percentile": 1746.43, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 616.16, "10th_percentile": 616.16, "90th_percentile": 616.16, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 616.16, "10th_percentile": 616.16, "90th_percentile": 654.67, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 616.16, "10th_percentile": 616.16, "90th_percentile": 654.67, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL A4217) STERILE WATER/SALINE, 500 ML", "code_information": [ { "code": "A4217", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 3.8, "maximum": 21.42, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.42 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 17.14 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 21.42 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 21.42 }, { "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" } ] } ] }, { "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, "discounted_cash": 340.0, "minimum": 340.3875, "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": "Ciprofloxacin 400 MG/200ML in D5W", "drug_information": { "unit": 200.0, "type": "ML" }, "code_information": [ { "code": "00409330001", "type": "NDC" }, { "code": "J0744", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 6.615, "maximum": 47.31, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 47.31 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.87 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 7.89 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 9.87 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 9.87 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.62 } ] } ] }, { "description": "HC ANTIHUMAN GLOBULIN INDIRECT EA ANTIBODY TITER", "code_information": [ { "code": "86886", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 299.38, "discounted_cash": 86.0, "minimum": 41.89, "maximum": 271.5377, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 42.74 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 52.37 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 41.89 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 52.37 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 52.37 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 48.02 } ] } ] }, { "description": "HC URINALYSIS, AUTO, W/SCOPE", "code_information": [ { "code": "81001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 72.81, "discounted_cash": 21.0, "minimum": 3.17, "maximum": 66.0387, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 41.71, "10th_percentile": 41.71, "90th_percentile": 45.14, "count": "19" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 20.97, "10th_percentile": 20.97, "90th_percentile": 20.97, "count": "54" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 26.17 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 32.07 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 20.21, "10th_percentile": 20.21, "90th_percentile": 20.21, "count": "85" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 25.66 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 32.07 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 32.07 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 46.66, "10th_percentile": 37.11, "90th_percentile": 47.77, "count": "19" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.39 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 58.25, "10th_percentile": 3.17, "90th_percentile": 58.25, "count": "37" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 13.54, "10th_percentile": 13.54, "90th_percentile": 13.54, "count": "1 through 10" }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 58.25, "10th_percentile": 58.25, "90th_percentile": 58.25, "count": "359" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 18.64, "10th_percentile": 3.17, "90th_percentile": 19.81, "count": "232" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 52.83, "10th_percentile": 46.56, "90th_percentile": 53.36, "count": "16" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 18.64, "10th_percentile": 18.64, "90th_percentile": 21.55, "count": "135" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 18.64, "10th_percentile": 18.64, "90th_percentile": 19.81, "count": "52" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 18.64, "10th_percentile": 18.64, "90th_percentile": 19.81, "count": "76" } ] } ] }, { "description": "HC (SUP SHELL Q4168) AMNIOBAND, 1 MG", "code_information": [ { "code": "Q4168", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 53.7075, "maximum": 80.1, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 80.1 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 64.08 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 80.1 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 80.1 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 53.71 } ] } ] }, { "description": "HC CANNABINOIDS NATURAL ASSAY - G0480 - 30100418", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 429.69, "minimum": 33.0774, "maximum": 1060.8233, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 429.69 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 429.69 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 429.69 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 429.69 }, { "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": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 173.49, "10th_percentile": 173.49, "90th_percentile": 173.49, "count": "1 through 10" }, { "payer_name": "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 432.75, "10th_percentile": 164.25, "90th_percentile": 1052.5, "count": "14" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 95.76, "10th_percentile": 95.76, "90th_percentile": 95.76, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 363.48, "10th_percentile": 363.48, "90th_percentile": 375.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 132.48, "10th_percentile": 132.48, "90th_percentile": 257.04, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 132.77, "10th_percentile": 132.77, "90th_percentile": 337.54, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 55.85, "10th_percentile": 55.85, "90th_percentile": 55.85, "count": "1 through 10" } ] } ] }, { "description": "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": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC (SUP SHELL A4373) SKIN BARRIER WITH FLANGE", "code_information": [ { "code": "A4373", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 8.94, "maximum": 8.94, "payers_information": [ { "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" } ] } ] }, { "description": "HC (SUP SHELL Q4118) MATRISTEM MICROMATRIX", "code_information": [ { "code": "Q4118", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 8.0325, "maximum": 47.92, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 47.92 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.98 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9.58 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 11.98 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 11.98 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.03 } ] } ] }, { "description": "ANGINA PECTORIS", "code_information": [ { "code": "311", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4259.0, "minimum": 4259.31, "maximum": 8274.69, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8274.69 } ] } ] }, { "description": "HC ASSAY URINE UREA-N", "code_information": [ { "code": "84540", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 84.06, "discounted_cash": 24.0, "minimum": 5.56, "maximum": 76.2424, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 39.18 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 48.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 38.4 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 48.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 48.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 51.54 }, { "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" } ] } ] }, { "description": "HC LYMPHANGIOGRAPHY PELVIC/ABDOMIN, BILAT", "code_information": [ { "code": "75807", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1977.19, "discounted_cash": 573.0, "minimum": 573.3851, "maximum": 1793.3113, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 974.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1194.1 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 955.27 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1194.1 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1194.1 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1748.28 } ] } ] }, { "description": "HC B-12 BINDING CAPACITY", "code_information": [ { "code": "82608", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 216.25, "discounted_cash": 62.0, "minimum": 14.32, "maximum": 196.1387, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 118.21 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 144.84 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 115.87 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 144.84 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 144.84 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 132.75 }, { "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" } ] } ] }, { "description": "KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC", "code_information": [ { "code": "690", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6276.0, "minimum": 6276.87, "maximum": 19795.734, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9543.18 } ] } ] }, { "description": "HC (SUP SHELL A4326) MALE EXTERNAL CATHETER", "code_information": [ { "code": "A4326", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 14.78, "maximum": 14.78, "payers_information": [ { "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" } ] } ] }, { "description": "VAGINAL DELIVERY WITH STERILIZATION ANDOR D&C WITH MCC", "code_information": [ { "code": "796", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7846.0, "minimum": 7846.09, "maximum": 13757.74, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13757.74 } ] } ] }, { "description": "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": 54.0, "minimum": 36.32, "maximum": 170.6339, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "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" } ] } ] }, { "description": "CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITHOUT MCC", "code_information": [ { "code": "324", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5156.0, "minimum": 5156.0, "maximum": 37147.08, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 37147.08 } ] } ] }, { "description": "HC ASSAY OF GLUCAGON", "code_information": [ { "code": "82943", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 246.88, "discounted_cash": 71.0, "minimum": 14.29, "maximum": 223.9202, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 117.92 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 144.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 115.6 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 144.5 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 144.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 132.48 }, { "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" } ] } ] }, { "description": "HC RUBEOLA", "code_information": [ { "code": "86765", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 56.25, "discounted_cash": 16.0, "minimum": 12.88, "maximum": 56.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 56.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 56.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 56.25 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 56.25 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 56.25 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 34.05, "10th_percentile": 34.05, "90th_percentile": 34.05, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 56.25 }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 42.5, "10th_percentile": 42.5, "90th_percentile": 45.0, "count": "12" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 14.4, "10th_percentile": 13.6, "90th_percentile": 14.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 38.93, "10th_percentile": 38.93, "90th_percentile": 40.82, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 14.4, "10th_percentile": 14.4, "90th_percentile": 14.4, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL A7507) INTEGRATED FILTER & HOLDER", "code_information": [ { "code": "A7507", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 3.56, "maximum": 3.56, "payers_information": [ { "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" } ] } ] }, { "description": "Ropivacaine HCl Inj 5 MG/ML", "drug_information": { "unit": 30.0, "type": "ML" }, "code_information": [ { "code": "63323028611", "type": "NDC" }, { "code": "J2795", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.19, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.19 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC MYCOPLASMA CULTURE", "code_information": [ { "code": "87109", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 307.81, "discounted_cash": 89.0, "minimum": 15.39, "maximum": 279.1837, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 127.03 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 155.65 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 124.52 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 155.65 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 155.65 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 142.67 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 15.39, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC COLLECT BLOOD FROM IMPLANT VENOUS ACCESS", "code_information": [ { "code": "36591", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 39.38, "discounted_cash": 11.0, "minimum": 11.4202, "maximum": 35.7177, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 10.4, "10th_percentile": 10.4, "90th_percentile": 10.92, "count": "15" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 31.5, "10th_percentile": 31.5, "90th_percentile": 31.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 31.5, "10th_percentile": 30.0, "90th_percentile": 31.5, "count": "34" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 10.08, "10th_percentile": 9.6, "90th_percentile": 10.08, "count": "35" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 10.08, "10th_percentile": 9.6, "90th_percentile": 10.08, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 10.08, "10th_percentile": 10.08, "90th_percentile": 10.2, "count": "12" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 10.08, "10th_percentile": 9.6, "90th_percentile": 10.2, "count": "14" } ] } ] }, { "description": "HC SMEAR,PRIMARY W/INTERP", "code_information": [ { "code": "87205", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 86.88, "discounted_cash": 25.0, "minimum": 4.27, "maximum": 78.8002, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 122.84, "10th_percentile": 122.84, "90th_percentile": 122.84, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 24.57, "10th_percentile": 23.22, "90th_percentile": 24.57, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 35.22 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 43.16 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 23.67, "10th_percentile": 22.37, "90th_percentile": 47.34, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 34.52 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 43.16 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 43.16 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 52.89, "10th_percentile": 52.89, "90th_percentile": 52.89, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 51.67, "10th_percentile": 51.67, "90th_percentile": 51.67, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.59 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 64.5, "10th_percentile": 45.35, "90th_percentile": 68.25, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 15.86, "10th_percentile": 15.86, "90th_percentile": 15.86, "count": "1 through 10" }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 68.25, "10th_percentile": 64.5, "90th_percentile": 68.25, "count": "39" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 21.84, "10th_percentile": 4.27, "90th_percentile": 43.68, "count": "20" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 61.9, "10th_percentile": 61.9, "90th_percentile": 124.94, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 21.84, "10th_percentile": 20.64, "90th_percentile": 65.52, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 21.84, "10th_percentile": 4.27, "90th_percentile": 65.79, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 21.84, "10th_percentile": 21.84, "90th_percentile": 21.84, "count": "1 through 10" } ] } ] }, { "description": "HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC", "code_information": [ { "code": "970", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16813.0, "minimum": 16813.05, "maximum": 31092.26, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 31092.26 } ] } ] }, { "description": "HC (SUP SHELL A4450) NON-WATERPROOF TAPE - A4450 - RU270002", "code_information": [ { "code": "A4450", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "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" } ] } ] }, { "description": "HIV WITH MAJOR RELATED CONDITION WITHOUT CCMCC", "code_information": [ { "code": "976", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6725.0, "minimum": 6725.22, "maximum": 10641.91, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10641.91 } ] } ] }, { "description": "HC (SUP SHELL Q4169) ARTACENT WOUND, PER SQ CM", "code_information": [ { "code": "Q4169", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 554.589, "maximum": 13273.16, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3797.95 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 13273.16 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 10618.42 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 13273.16 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 13273.16 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 554.59 } ] } ] }, { "description": "HC (SUP SHELL A6252) ABSORPT DRG >16 <=48 W/O BDR - A6252 - RU272054", "code_information": [ { "code": "A6252", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 4.64, "maximum": 4.64, "payers_information": [ { "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" } ] } ] }, { "description": "SKIN ULCERS WITH MCC", "code_information": [ { "code": "592", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12777.0, "minimum": 12777.92, "maximum": 35512.293, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 12777.92, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 3899.84, "10th_percentile": 3899.84, "90th_percentile": 3899.84, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22815.21 } ] } ] }, { "description": "Medroxyprogesterone Acetate IM Susp 150 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "55150032901", "type": "NDC" }, { "code": "J1050", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.7955, "maximum": 8.24, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.24 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2.68 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2.14 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2.68 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2.68 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.8 } ] } ] }, { "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": 551.0, "minimum": 551.3625, "maximum": 1744.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 1027.46, "10th_percentile": 1027.46, "90th_percentile": 1027.46, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 273.78, "10th_percentile": 258.3, "90th_percentile": 273.78, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1744.7 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 497.66, "10th_percentile": 497.66, "90th_percentile": 527.48, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1395.75 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1744.7 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1744.7 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1700.33 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 685.66, "10th_percentile": 685.66, "90th_percentile": 923.82, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1521.0, "10th_percentile": 1435.0, "90th_percentile": 1521.0, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 459.2, "10th_percentile": 459.2, "90th_percentile": 486.72, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 1379.55, "10th_percentile": 1314.46, "90th_percentile": 1393.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 486.72, "10th_percentile": 459.2, "90th_percentile": 486.72, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 486.72, "10th_percentile": 459.2, "90th_percentile": 486.72, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 486.72, "10th_percentile": 459.2, "90th_percentile": 486.72, "count": "1 through 10" } ] } ] }, { "description": "HC MRI UPPER EXTREMITY W/O CONTRAST", "code_information": [ { "code": "73218", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2335.94, "discounted_cash": 677.0, "minimum": 677.4226, "maximum": 2118.6976, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1725.03 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1380.01 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1725.03 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1725.03 }, { "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": 2103.53 } ] } ] }, { "description": "HC URINE BACT CULT ID", "code_information": [ { "code": "87088", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 183.13, "discounted_cash": 53.0, "minimum": 8.09, "maximum": 166.0989, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 98.99, "10th_percentile": 98.99, "90th_percentile": 112.51, "count": "15" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 52.74, "10th_percentile": 49.77, "90th_percentile": 52.74, "count": "40" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 66.82 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 81.88 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 50.81, "10th_percentile": 47.95, "90th_percentile": 50.81, "count": "58" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 65.5 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 81.88 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 81.88 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 93.32, "10th_percentile": 88.07, "90th_percentile": 117.35, "count": "16" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 115.15, "10th_percentile": 110.75, "90th_percentile": 115.15, "count": "13" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 75.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 63.04, "10th_percentile": 11.02, "90th_percentile": 146.5, "count": "37" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 34.05, "10th_percentile": 34.05, "90th_percentile": 34.05, "count": "1 through 10" }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 146.5, "10th_percentile": 138.25, "90th_percentile": 146.5, "count": "301" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 44.24, "10th_percentile": 8.09, "90th_percentile": 46.88, "count": "204" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 126.64, "10th_percentile": 126.64, "90th_percentile": 132.88, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 46.88, "10th_percentile": 44.24, "90th_percentile": 51.15, "count": "116" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 46.88, "10th_percentile": 44.24, "90th_percentile": 47.01, "count": "25" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 46.88, "10th_percentile": 44.24, "90th_percentile": 47.01, "count": "58" } ] } ] }, { "description": "Pneumococcal Vaccine Polyvalent Soln Pref Syr 25 MCG/0.5ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00006483703", "type": "NDC" }, { "code": "90732", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 420.462, "maximum": 1583.7, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1583.7 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 627.02 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 501.61 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 627.02 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 627.02 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 420.46 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 168.67, "10th_percentile": 168.67, "90th_percentile": 168.67, "count": "1 through 10" } ] } ] }, { "description": "HC PH BODY FLUID NOS", "code_information": [ { "code": "83986", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 78.44, "discounted_cash": 22.0, "minimum": 3.58, "maximum": 71.1451, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 28.77 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 35.26 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 21.77, "10th_percentile": 21.77, "90th_percentile": 21.77, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 28.21 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 35.26 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 35.26 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.19 }, { "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" } ] } ] }, { "description": "HC (SUP SHELL L3923) HFO WITHOUT JOINTS PRE CST", "code_information": [ { "code": "L3923", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 130.42, "maximum": 130.42, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 130.42, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A7525) TRACHEOSTOMY MASK - A7525 - 27100101", "code_information": [ { "code": "A7525", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2.94, "maximum": 2.94, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2.94, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY GUIDE, GU DILATION", "code_information": [ { "code": "74485", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10138.1, "discounted_cash": 2940.0, "minimum": 357.49, "maximum": 9195.2567, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 364.69 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 446.87 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 357.49 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 446.87 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 446.87 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 685.17 } ] } ] }, { "description": "HC (SUP SHELL A4209) 5+ CC STERILE SYRINGE&NEEDLE", "code_information": [ { "code": "A4209", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.17, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.17 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.17 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.17 } ] } ] }, { "description": "WOUND DEBRIDEMENTS FOR INJURIES WITH CC", "code_information": [ { "code": "902", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10536.0, "minimum": 10536.18, "maximum": 22570.0, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22570.0 } ] } ] }, { "description": "HC ANGIO PULMON BILAT NONSELEC", "code_information": [ { "code": "75746", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2587.19, "discounted_cash": 750.0, "minimum": 702.1101, "maximum": 2346.5813, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 894.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1095.76 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 876.6 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1095.76 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1095.76 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 702.11 } ] } ] }, { "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": 76.8, "median_amount": 12.77, "10th_percentile": 12.77, "90th_percentile": 13.54, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "KIDNEY AND URINARY TRACT NEOPLASMS WITH CC", "code_information": [ { "code": "687", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7397.0, "minimum": 7397.74, "maximum": 12352.49, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12352.49 } ] } ] }, { "description": "GASTROINTESTINAL OBSTRUCTION WITHOUT CCMCC", "code_information": [ { "code": "390", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4931.0, "minimum": 4931.83, "maximum": 6413.21, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6413.21 } ] } ] }, { "description": "HC ED LEVEL 1", "code_information": [ { "code": "99281", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 314.69, "discounted_cash": 91.0, "minimum": 91.2601, "maximum": 314.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 78.84, "10th_percentile": 78.84, "90th_percentile": 78.84, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 296.19 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 314.69 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 290.36 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.1, "median_amount": 8.53, "10th_percentile": 8.53, "90th_percentile": 8.53, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 197.88, "10th_percentile": 197.88, "90th_percentile": 197.88, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 79.93, "median_amount": 175.05, "10th_percentile": 175.05, "90th_percentile": 175.05, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 139.12, "10th_percentile": 74.46, "90th_percentile": 186.8, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 251.75, "10th_percentile": 219.0, "90th_percentile": 251.75, "count": "45" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 80.56, "10th_percentile": 73.01, "90th_percentile": 80.56, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 228.34, "10th_percentile": 228.34, "90th_percentile": 228.34, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 80.56, "10th_percentile": 80.56, "90th_percentile": 81.03, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 70.08, "10th_percentile": 70.08, "90th_percentile": 80.56, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 70.08, "10th_percentile": 70.08, "90th_percentile": 70.08, "count": "1 through 10" } ] } ] }, { "description": "HC ANGIOTENSIN I ENZYME TEST", "code_information": [ { "code": "82164", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 279.69, "discounted_cash": 81.0, "minimum": 14.6, "maximum": 253.6788, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 120.47 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 147.61 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 118.09 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 147.61 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 147.61 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 142.53, "10th_percentile": 142.53, "90th_percentile": 142.53, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 135.35 }, { "payer_name": "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 223.75, "10th_percentile": 223.75, "90th_percentile": 223.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 14.6, "10th_percentile": 14.6, "90th_percentile": 14.6, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 71.6, "10th_percentile": 71.6, "90th_percentile": 71.6, "count": "1 through 10" } ] } ] }, { "description": "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": 33.0, "minimum": 18.18, "maximum": 105.4387, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "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" } ] } ] }, { "description": "KIDNEY TRANSPLANT", "code_information": [ { "code": "652", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9639.0, "minimum": 9639.48, "maximum": 38072.51, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 38072.51 } ] } ] }, { "description": "HC (SUP SHELL A6011) COLLAGEN GEL/PASTE WOUND FIL", "code_information": [ { "code": "A6011", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 3.25, "maximum": 3.25, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3.25, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Levofloxacin in D5W IV Soln 500 MG/100ML", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "00143972101", "type": "NDC" }, { "code": "J1956", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 3.2445, "maximum": 18.36, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.24 }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.36 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.79 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3.83 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 4.79 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 4.79 } ] } ] }, { "description": "HC (SUP SHELL L8600) IMPLANT BREAST SILICONE/EQ", "code_information": [ { "code": "L8600", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 771.14, "maximum": 771.14, "payers_information": [ { "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" } ] } ] }, { "description": "HC DNA ANTIBODY, NATV/2 STRAND", "code_information": [ { "code": "86225", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 180.0, "discounted_cash": 52.0, "minimum": 13.74, "maximum": 163.26, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 117.31, "10th_percentile": 117.31, "90th_percentile": 117.31, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 51.84, "10th_percentile": 51.84, "90th_percentile": 51.84, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 113.4 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 138.96 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 111.16 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 138.96 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 138.96 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 127.38 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 144.0, "10th_percentile": 144.0, "90th_percentile": 152.75, "count": "12" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 48.88, "10th_percentile": 48.88, "90th_percentile": 48.88, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 46.08, "10th_percentile": 46.08, "90th_percentile": 48.88, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 46.08, "10th_percentile": 46.08, "90th_percentile": 46.08, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL A6455) SELF-ADHER BAND >=5/YD - A6455 - 27100098", "code_information": [ { "code": "A6455", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.99, "maximum": 1.99, "payers_information": [ { "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" } ] } ] }, { "description": "Immune Globulin (Human) IV or Subcutaneous Soln 5 GM/50ML", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "00944270005", "type": "NDC" }, { "code": "J1561", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 152.3025, "maximum": 605.7, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 605.7 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 227.09 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 181.67 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 227.09 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 227.09 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 152.3 } ] } ] }, { "description": "HC COLLECTION CAPILLARY BLOOD SPECIMEN", "code_information": [ { "code": "36416", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 24.06, "discounted_cash": 6.0, "minimum": 6.9774, "maximum": 21.8224, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 19.25, "10th_percentile": 19.25, "90th_percentile": 19.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 5.95, "10th_percentile": 5.6, "90th_percentile": 6.16, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 93.6, "10th_percentile": 7.12, "90th_percentile": 126.7, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 6.16, "10th_percentile": 5.6, "90th_percentile": 6.16, "count": "1 through 10" } ] } ] }, { "description": "HC X-RAY TMJ UNILAT", "code_information": [ { "code": "70328", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 387.81, "discounted_cash": 112.0, "minimum": 80.1, "maximum": 351.7437, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 81.71 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 100.12 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 80.1 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 100.12 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 100.12 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 219.97 } ] } ] }, { "description": "HC (SUP SHELL Q4040) CAST SUP SHRT LEG PED FBRGLS", "code_information": [ { "code": "Q4040", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 26.23, "maximum": 26.23, "payers_information": [ { "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" } ] } ] }, { "description": "HC (SUP SHELL A4355) BLADDER IRRIGATION TUBING", "code_information": [ { "code": "A4355", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 10.8, "maximum": 10.8, "payers_information": [ { "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" } ] } ] }, { "description": "REHABILITATION WITH CCMCC", "code_information": [ { "code": "945", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12553.0, "minimum": 12553.74, "maximum": 18256.41, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18256.41 } ] } ] }, { "description": "HC CARD BL POOL PLNR MLT STDY WAL MOTN EJECT FRACT", "code_information": [ { "code": "78483", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 419.38, "discounted_cash": 121.0, "minimum": 121.6202, "maximum": 419.38, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 419.38 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 419.38 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 419.38 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 419.38 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 419.38 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 419.38 } ] } ] }, { "description": "HC HEPATITIS BE AB TEST", "code_information": [ { "code": "86707", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 144.06, "discounted_cash": 41.0, "minimum": 11.57, "maximum": 130.6624, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 95.48 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 117.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 93.6 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 117.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 117.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 107.26 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 108.75, "10th_percentile": 108.75, "90th_percentile": 115.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 34.8, "10th_percentile": 34.8, "90th_percentile": 34.8, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 36.88, "10th_percentile": 36.88, "90th_percentile": 36.88, "count": "1 through 10" } ] } ] }, { "description": "DIGESTIVE MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "376", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5156.0, "minimum": 5156.0, "maximum": 10896.55, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10896.55 } ] } ] }, { "description": "HC PHOSPHOLIPID NEUTRALIZ, HEXAGONAL PHOSPHOLIPID", "code_information": [ { "code": "85598", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 124.69, "discounted_cash": 36.0, "minimum": 17.98, "maximum": 124.69, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 37.14 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 45.51 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 34.6, "10th_percentile": 34.6, "90th_percentile": 34.6, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 36.41 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 45.51 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 45.51 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 124.69 }, { "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" } ] } ] }, { "description": "HC ASSAY OF OXALATE", "code_information": [ { "code": "83945", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 211.56, "discounted_cash": 61.0, "minimum": 14.45, "maximum": 191.8849, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 106.28 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 130.23 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 104.18 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 130.23 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 130.23 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 133.96 }, { "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" } ] } ] }, { "description": "BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CCMCC", "code_information": [ { "code": "584", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7397.0, "minimum": 7397.74, "maximum": 25236.67, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25236.67 } ] } ] }, { "description": "HC RO SET RADN THERAPY FIELD SIMPLE", "code_information": [ { "code": "77280", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1289.06, "discounted_cash": 373.0, "minimum": 373.8274, "maximum": 1169.1774, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 602.49 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 738.26 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 590.6 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 738.26 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 738.26 } ] } ] }, { "description": "HC PROTEIN TOT XCPT REFRACTOMETRY SERUM", "code_information": [ { "code": "84155", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 94.38, "discounted_cash": 27.0, "minimum": 3.67, "maximum": 85.6027, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 25.92, "10th_percentile": 25.92, "90th_percentile": 25.92, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 30.24 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 37.06 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 26.18, "10th_percentile": 26.18, "90th_percentile": 26.18, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 29.65 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 37.06 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 37.06 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.02 }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 75.5, "10th_percentile": 75.5, "90th_percentile": 75.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 23.04, "10th_percentile": 23.04, "90th_percentile": 23.04, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 23.04, "10th_percentile": 23.04, "90th_percentile": 24.16, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 23.04, "10th_percentile": 23.04, "90th_percentile": 23.04, "count": "1 through 10" } ] } ] }, { "description": "Piperacillin Sod-Tazobactam Sod For Inj 2.25 GM (2-0.25 GM)", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "60505615600", "type": "NDC" }, { "code": "J2543", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 3.528, "maximum": 40.14, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 40.14 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.26 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.21 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 5.26 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 5.26 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.53 } ] } ] }, { "description": "HC RADIOLOGIC EXAM ABDOMEN 3+ VIEWS", "code_information": [ { "code": "74021", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 769.06, "discounted_cash": 223.0, "minimum": 101.35, "maximum": 697.5374, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 103.39 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 126.69 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 101.35 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 126.69 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 126.69 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 256.57 } ] } ] }, { "description": "HC US,PREGNANT UTERUS,TRANSVAGINAL", "code_information": [ { "code": "76817", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 699.06, "discounted_cash": 202.0, "minimum": 202.7274, "maximum": 634.0474, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 377.69, "10th_percentile": 377.69, "90th_percentile": 429.5, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 309.28 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 247.42 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 309.28 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 309.28 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 356.24, "10th_percentile": 356.24, "90th_percentile": 356.24, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 485.01 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 559.25, "10th_percentile": 527.5, "90th_percentile": 559.25, "count": "21" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 483.19, "10th_percentile": 483.19, "90th_percentile": 483.19, "count": "1 through 10" } ] } ] }, { "description": "HC FLOWCYTOMETRY/ TECH COMPONENT, 1 MARKER", "code_information": [ { "code": "88184", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 270.31, "discounted_cash": 78.0, "minimum": 78.3899, "maximum": 270.31, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 270.31 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 252.75, "10th_percentile": 252.75, "90th_percentile": 252.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 80.88, "10th_percentile": 80.88, "90th_percentile": 80.88, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 80.88, "10th_percentile": 80.88, "90th_percentile": 80.88, "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": 30.0, "minimum": 30.6327, "maximum": 95.8064, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 44.32 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 54.31 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 43.45 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 54.31 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 54.31 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 49.97 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 80.25, "10th_percentile": 80.25, "90th_percentile": 208.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 25.68, "10th_percentile": 25.68, "90th_percentile": 92.56, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 27.29, "10th_percentile": 27.29, "90th_percentile": 27.29, "count": "1 through 10" } ] } ] }, { "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": 1.17, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 150.42, "10th_percentile": 46.15, "90th_percentile": 418.56, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.17 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.17 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.17 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC THAW PLASMA FRESH FROZEN EA UNIT", "code_information": [ { "code": "86927", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1036.88, "discounted_cash": 300.0, "minimum": 218.2276, "maximum": 940.4502, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 218.23 } ] } ] }, { "description": "HC NUCLEAR THERAPY, IV", "code_information": [ { "code": "79101", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 746.25, "discounted_cash": 216.0, "minimum": 216.4125, "maximum": 676.8487, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 275.7 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 337.83 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 270.26 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 337.83 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 337.83 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 454.01 } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITH MCC", "code_information": [ { "code": "347", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12329.0, "minimum": 12329.57, "maximum": 27062.78, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27062.78 } ] } ] }, { "description": "Filgrastim-sndz Soln Prefilled Syringe 480 MCG/0.8ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "61314032601", "type": "NDC" }, { "code": "Q5101", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0395, "maximum": 9.55, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.55 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.55 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.24 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.55 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.55 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.04 } ] } ] }, { "description": "HC (SUP SHELL A6452) HIGH COMPRES BAND W>=3<5YD - A6452 - 27100095", "code_information": [ { "code": "A6452", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 8.4, "maximum": 8.4, "payers_information": [ { "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" } ] } ] }, { "description": "HC ASSAY OF ESTRIOL", "code_information": [ { "code": "82677", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 359.38, "discounted_cash": 104.0, "minimum": 24.18, "maximum": 325.9577, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 186.67 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 228.73 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 182.98 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 228.73 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 228.73 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 224.16 }, { "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" } ] } ] }, { "description": "HC ASSAY OF ETHANOL - 80320 - 30100052", "code_information": [ { "code": "80320", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1165.0, "discounted_cash": 337.0, "minimum": 103.9223, "maximum": 1056.655, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 103.92 } ] } ] }, { "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": 13.8, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.8 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.08 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.08 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.08 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC IRON BINDING TEST", "code_information": [ { "code": "83550", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 134.06, "discounted_cash": 38.0, "minimum": 8.74, "maximum": 121.5924, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 34.32, "10th_percentile": 34.32, "90th_percentile": 36.47, "count": "19" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 34.32, "10th_percentile": 34.32, "90th_percentile": 36.47, "count": "35" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 76.79, "10th_percentile": 76.79, "90th_percentile": 82.37, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 38.61, "10th_percentile": 38.61, "90th_percentile": 38.61, "count": "21" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 88.46 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 37.2, "10th_percentile": 37.2, "90th_percentile": 37.2, "count": "17" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 70.77 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 88.46 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 88.46 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 68.32, "10th_percentile": 68.32, "90th_percentile": 68.32, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 85.92, "10th_percentile": 84.3, "90th_percentile": 85.92, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 81.02 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 107.25, "10th_percentile": 76.71, "90th_percentile": 107.25, "count": "23" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 24.93, "10th_percentile": 24.93, "90th_percentile": 24.93, "count": "1 through 10" }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 107.25, "10th_percentile": 107.25, "90th_percentile": 107.25, "count": "118" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 34.32, "10th_percentile": 31.1, "90th_percentile": 34.32, "count": "79" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 97.28, "10th_percentile": 85.72, "90th_percentile": 98.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 34.32, "10th_percentile": 34.32, "90th_percentile": 39.68, "count": "55" } ] } ] }, { "description": "HC (SUP SHELL A6266) IMPREG GAUZE NO H20/SAL/YARD - A6266 - RU272007", "code_information": [ { "code": "A6266", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2.72, "maximum": 2.72, "payers_information": [ { "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" } ] } ] }, { "description": "HC (SUP SHELL A4340) INDWELLING CATHETER SPECIAL - A4340 - RU278115", "code_information": [ { "code": "A4340", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 45.25, "maximum": 45.25, "payers_information": [ { "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" } ] } ] }, { "description": "HC (SUP SHELL A4626) TRACHEOSTOMY CLEANING BRUSH", "code_information": [ { "code": "A4626", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 4.54, "maximum": 4.54, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.54, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "KIDNEY AND URINARY TRACT INFECTIONS WITH MCC", "code_information": [ { "code": "689", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8518.0, "minimum": 8518.61, "maximum": 17535.8047, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "other", "standard_charge_dollar": 8518.61, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 9840.0, "10th_percentile": 9840.0, "90th_percentile": 9840.0, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13678.75 } ] } ] }, { "description": "HC QUANTITATIVE SCREEN, METALS", "code_information": [ { "code": "83018", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 100.94, "discounted_cash": 29.0, "minimum": 21.96, "maximum": 100.94, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 100.94 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 100.94 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 100.94 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 100.94 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 100.94 }, { "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" } ] } ] }, { "description": "HC VIRUS, NOT SPECIFIED", "code_information": [ { "code": "86790", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 130.63, "discounted_cash": 37.0, "minimum": 12.88, "maximum": 119.404, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 76.83 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 94.14 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 75.31 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 94.14 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 94.14 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 119.4 }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 2572.75, "10th_percentile": 2572.75, "90th_percentile": 2572.75, "count": "1 through 10" } ] } ] }, { "description": "HC US, OB < 14 WKS, ADD'L FETUS", "code_information": [ { "code": "76802", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 414.38, "discounted_cash": 120.0, "minimum": 120.1702, "maximum": 375.8427, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 162.67 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 130.13 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 162.67 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 162.67 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 177.63 } ] } ] }, { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CCMCC", "code_information": [ { "code": "017", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18606.0, "minimum": 18606.44, "maximum": 64041.28, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 64041.28 } ] } ] }, { "description": "HC OFFICE/OUTPATIENT NEW SF MDM 15-29 MINUTES - 99202 - 76100002", "code_information": [ { "code": "99202", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 175.63, "discounted_cash": 50.0, "minimum": 50.9327, "maximum": 159.2964, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 104.36, "10th_percentile": 104.36, "90th_percentile": 104.36, "count": "1 through 10" } ] } ] }, { "description": "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": 262.0, "minimum": 262.9024, "maximum": 900.0, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 } ] } ] }, { "description": "HC ASSAY OF TOBRAMYCIN", "code_information": [ { "code": "80200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 270.94, "discounted_cash": 78.0, "minimum": 16.13, "maximum": 245.7426, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 133.02 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 162.99 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 130.39 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 162.99 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 162.99 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 149.53 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Neostigmine Methylsulfate Inj 1 MG/ML", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "71288050110", "type": "NDC" }, { "code": "J2710", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2.583, "maximum": 65.56, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 65.56 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.85 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3.08 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 3.85 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 3.85 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2.58 } ] } ] }, { "description": "HC COCCIDIOIDES, ANTIBODY", "code_information": [ { "code": "86635", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 81.56, "discounted_cash": 23.0, "minimum": 11.47, "maximum": 81.56, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 81.56 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 81.56 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 81.56 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 81.56 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 81.56 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 81.56 }, { "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" } ] } ] }, { "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", "minimum": 1166.949, "maximum": 3992.71, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3992.71 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1740.35 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1392.26 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1740.35 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1740.35 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1166.95 } ] } ] }, { "description": "O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CCMCC", "code_information": [ { "code": "941", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4259.0, "minimum": 4259.31, "maximum": 23904.51, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23904.51 } ] } ] }, { "description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC", "code_information": [ { "code": "433", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7397.0, "minimum": 7397.74, "maximum": 22817.691, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "other", "standard_charge_dollar": 7730.65, "standard_charge_algorithm": "2342.62 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 25352.99, "10th_percentile": 25352.99, "90th_percentile": 25352.99, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12451.52 } ] } ] }, { "description": "HC (SUP SHELL Q4112) CYMETRA INJECTABLE", "code_information": [ { "code": "Q4112", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2747.052, "maximum": 14294.55, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14294.55 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2747.05 } ] } ] }, { "description": "PERITONEAL ADHESIOLYSIS WITH MCC", "code_information": [ { "code": "335", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19278.0, "minimum": 19278.96, "maximum": 42097.27, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 42097.27 } ] } ] }, { "description": "Levetiracetam Inj 500 MG/5ML (100 MG/ML)", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "00409188622", "type": "NDC" }, { "code": "J1953", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.76, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.76 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC IRRADIATION BLOOD PRODUCT, PER UNIT", "code_information": [ { "code": "86945", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 172.19, "discounted_cash": 49.0, "minimum": 49.9351, "maximum": 172.19, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 172.19 } ] } ] }, { "description": "MALIGNANT BREAST DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "599", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5380.0, "minimum": 5380.18, "maximum": 9070.44, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9070.44 } ] } ] }, { "description": "HC (SUP SHELL Q4121) THERASKIN", "code_information": [ { "code": "Q4121", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 163.1385, "maximum": 660.1, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 660.1 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 243.3 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 194.64 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 243.3 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 243.3 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 163.14 } ] } ] }, { "description": "HC CT GUIDE FOR TISSUE ABLATION", "code_information": [ { "code": "77013", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 476.25, "discounted_cash": 138.0, "minimum": 138.1125, "maximum": 476.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 476.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 476.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 476.25 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 476.25 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 476.25 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 476.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 476.25 } ] } ] }, { "description": "HC FATS/LIPIDS, FECES, QUANTITATIVE", "code_information": [ { "code": "82710", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 241.88, "discounted_cash": 70.0, "minimum": 16.8, "maximum": 219.3852, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 138.67 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 169.92 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 135.94 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 169.92 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 169.92 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 155.74 }, { "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": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 61.92, "10th_percentile": 61.92, "90th_percentile": 61.92, "count": "1 through 10" } ] } ] }, { "description": "HC ASSAY OF SELENIUM", "code_information": [ { "code": "84255", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 346.88, "discounted_cash": 100.0, "minimum": 25.53, "maximum": 314.6202, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 210.69 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 258.17 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 206.54 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 258.17 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 258.17 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 236.68 }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 277.5, "10th_percentile": 277.5, "90th_percentile": 277.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 88.8, "10th_percentile": 88.8, "90th_percentile": 88.8, "count": "1 through 10" } ] } ] }, { "description": "HC X-RAY COLON AIR CONTRAST", "code_information": [ { "code": "74280", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1600.63, "discounted_cash": 464.0, "minimum": 464.1827, "maximum": 1451.7714, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 577.69 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 707.87 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 566.3 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 707.87 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 707.87 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1359.15 } ] } ] }, { "description": "HC MAMMARY DUCTOGRAM, SINGLE", "code_information": [ { "code": "77053", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 533.13, "discounted_cash": 154.0, "minimum": 154.6077, "maximum": 483.5489, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 236.34 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 289.6 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 231.68 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 289.6 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 289.6 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 312.98 } ] } ] }, { "description": "HC MRI JOINT OF LEG. COMBO", "code_information": [ { "code": "73723", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3750.94, "discounted_cash": 1087.0, "minimum": 900.0, "maximum": 3402.1026, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2668.87 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2135.09 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2668.87 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2668.87 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2503.99 } ] } ] }, { "description": "HC FIBRIN DEGRADPRODUCTS,D-DIMER, ULTRASENS", "code_information": [ { "code": "85380", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 187.19, "discounted_cash": 54.0, "minimum": 10.18, "maximum": 169.7813, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 101.14, "10th_percentile": 101.14, "90th_percentile": 101.14, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 50.85, "10th_percentile": 50.85, "90th_percentile": 50.85, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 83.95 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 102.87 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 51.94, "10th_percentile": 48.99, "90th_percentile": 51.94, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 82.29 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 102.87 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 102.87 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 119.95, "10th_percentile": 115.82, "90th_percentile": 119.95, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 113.16, "10th_percentile": 113.16, "90th_percentile": 117.7, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 94.37 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 108.43, "10th_percentile": 26.91, "90th_percentile": 149.75, "count": "1 through 10" }, { "payer_name": "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 141.25, "10th_percentile": 141.25, "90th_percentile": 149.75, "count": "65" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 47.92, "10th_percentile": 45.2, "90th_percentile": 48.03, "count": "16" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 129.39, "10th_percentile": 119.7, "90th_percentile": 135.82, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 47.92, "10th_percentile": 45.2, "90th_percentile": 47.92, "count": "16" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 47.92, "10th_percentile": 45.2, "90th_percentile": 48.03, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 47.92, "10th_percentile": 45.2, "90th_percentile": 48.03, "count": "1 through 10" } ] } ] }, { "description": "GASTROINTESTINAL HEMORRHAGE WITH MCC", "code_information": [ { "code": "377", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10087.0, "minimum": 10087.83, "maximum": 48731.049, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21550.26 } ] } ] }, { "description": "HC SMEAR COMPLEX STAIN", "code_information": [ { "code": "87209", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 168.75, "discounted_cash": 48.0, "minimum": 17.98, "maximum": 168.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 148.34 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 168.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 44.14, "10th_percentile": 44.14, "90th_percentile": 44.14, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 145.41 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 168.75 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 168.75 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 81.06, "10th_percentile": 81.06, "90th_percentile": 81.06, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 101.94, "10th_percentile": 101.94, "90th_percentile": 101.94, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 166.68 }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 135.0, "10th_percentile": 127.25, "90th_percentile": 135.0, "count": "17" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 17.98, "10th_percentile": 17.98, "90th_percentile": 43.2, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 122.45, "10th_percentile": 101.71, "90th_percentile": 122.45, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 40.72, "10th_percentile": 40.72, "90th_percentile": 43.2, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 17.98, "10th_percentile": 17.98, "90th_percentile": 17.98, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 43.2, "10th_percentile": 43.2, "90th_percentile": 43.2, "count": "1 through 10" } ] } ] }, { "description": "HC ASSAY OF MAGNESIUM", "code_information": [ { "code": "83735", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 107.5, "discounted_cash": 31.0, "minimum": 6.7, "maximum": 97.5025, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 61.58, "10th_percentile": 61.58, "90th_percentile": 61.58, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 30.96, "10th_percentile": 30.96, "90th_percentile": 30.96, "count": "23" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 55.29 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 67.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 29.82, "10th_percentile": 29.82, "90th_percentile": 29.82, "count": "46" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 54.2 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 67.75 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 67.75 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 68.89, "10th_percentile": 54.78, "90th_percentile": 70.52, "count": "13" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 67.6, "10th_percentile": 67.6, "90th_percentile": 68.89, "count": "20" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 62.11 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 86.0, "10th_percentile": 34.73, "90th_percentile": 86.0, "count": "30" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 19.99, "10th_percentile": 19.99, "90th_percentile": 19.99, "count": "1 through 10" }, { "payer_name": "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 86.0, "10th_percentile": 86.0, "90th_percentile": 86.0, "count": "278" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 27.52, "10th_percentile": 27.52, "90th_percentile": 27.52, "count": "128" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 78.0, "10th_percentile": 68.74, "90th_percentile": 78.78, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 27.52, "10th_percentile": 27.52, "90th_percentile": 31.82, "count": "82" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 27.52, "10th_percentile": 27.2, "90th_percentile": 29.24, "count": "48" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 27.52, "10th_percentile": 27.52, "90th_percentile": 29.24, "count": "89" } ] } ] }, { "description": "HC CHROMOTOGRAPHY, QUANT, SINGLE", "code_information": [ { "code": "82542", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1084.38, "discounted_cash": 314.0, "minimum": 24.09, "maximum": 983.5327, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 149.07 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 182.66 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 146.13 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 182.66 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 182.66 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 223.33 }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 867.5, "10th_percentile": 209.75, "90th_percentile": 867.5, "count": "1 through 10" } ] } ] }, { "description": "HC IMMUNOASSAY, TUMOR ANTIGEN, CA 15-3", "code_information": [ { "code": "86300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 154.69, "discounted_cash": 44.0, "minimum": 20.81, "maximum": 154.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 44.55, "10th_percentile": 42.03, "90th_percentile": 44.55, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 154.69 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 154.69 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 40.49, "10th_percentile": 40.49, "90th_percentile": 42.92, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 154.69 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 154.69 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 154.69 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 154.69 }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 116.75, "10th_percentile": 116.75, "90th_percentile": 123.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 39.6, "10th_percentile": 37.36, "90th_percentile": 39.7, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 39.6, "10th_percentile": 39.6, "90th_percentile": 39.6, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 39.6, "10th_percentile": 39.6, "90th_percentile": 39.6, "count": "1 through 10" } ] } ] }, { "description": "HC PHENOTYPE INFECT AGENT DRUG", "code_information": [ { "code": "87900", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1351.56, "discounted_cash": 391.0, "minimum": 130.35, "maximum": 1318.28, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1075.84 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1318.28 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1054.62 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1318.28 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1318.28 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1208.41 }, { "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" } ] } ] }, { "description": "HC ASSAY OF COPPER", "code_information": [ { "code": "82525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 136.25, "discounted_cash": 39.0, "minimum": 12.41, "maximum": 125.52, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 78.04, "10th_percentile": 78.04, "90th_percentile": 78.04, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 102.43 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 125.52 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 100.41 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 125.52 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 125.52 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 87.32, "10th_percentile": 85.67, "90th_percentile": 87.32, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 115.05 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 109.0, "10th_percentile": 109.0, "90th_percentile": 109.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 34.88, "10th_percentile": 34.88, "90th_percentile": 34.88, "count": "1 through 10" } ] } ] }, { "description": "DISORDERS OF THE BILIARY TRACT WITH CC", "code_information": [ { "code": "445", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6725.0, "minimum": 6725.22, "maximum": 12901.86, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12901.86 } ] } ] }, { "description": "HC CYTOGENETICS DNA PROBE", "code_information": [ { "code": "88271", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1231.56, "discounted_cash": 357.0, "minimum": 21.42, "maximum": 1117.0249, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 176.77 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 216.61 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 173.29 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 216.61 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 216.61 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 198.57 }, { "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" } ] } ] }, { "description": "MAJOR SKIN DISORDERS WITH MCC", "code_information": [ { "code": "595", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12105.0, "minimum": 12105.4, "maximum": 25000.89, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25000.89 } ] } ] }, { "description": "CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC", "code_information": [ { "code": "307", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4931.0, "minimum": 4931.83, "maximum": 10765.7, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10765.7 } ] } ] }, { "description": "HC COMPLEMENT/FUNCTION ACTIVITY", "code_information": [ { "code": "86161", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 255.0, "discounted_cash": 73.0, "minimum": 12.0, "maximum": 231.285, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 92.03 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 112.77 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 90.22 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 112.77 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 112.77 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 111.25 }, { "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" } ] } ] }, { "description": "HC SURG PATH,GROSS,LEVEL I", "code_information": [ { "code": "88300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 156.25, "discounted_cash": 45.0, "minimum": 45.3125, "maximum": 141.7188, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 137.76 } ] } ] }, { "description": "HC IMMUNODIFFUSION", "code_information": [ { "code": "86329", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 117.5, "discounted_cash": 34.0, "minimum": 14.05, "maximum": 117.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 115.95 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 117.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 113.66 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 117.5 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 117.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 117.5 }, { "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" } ] } ] }, { "description": "HC DUPLEX ABD/PEL VASC STUDY,COMPLETE", "code_information": [ { "code": "93975", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2032.81, "discounted_cash": 589.0, "minimum": 589.5149, "maximum": 1843.7587, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 869.22, "10th_percentile": 869.22, "90th_percentile": 988.22, "count": "1 through 10" } ] } ] }, { "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": 1.76, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 126.67, "10th_percentile": 126.67, "90th_percentile": 126.67, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.76 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC (SUP SHELL A5062) DRNBLE OSTOMY POUCH W/O BARR", "code_information": [ { "code": "A5062", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 3.18, "maximum": 3.18, "payers_information": [ { "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" } ] } ] }, { "description": "HC SPECTROPHOTOMETRY", "code_information": [ { "code": "84311", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 198.75, "discounted_cash": 57.0, "minimum": 8.1, "maximum": 180.2663, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 57.66 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 70.66 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 56.52 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 70.66 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 70.66 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 75.09 }, { "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" } ] } ] }, { "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": 21.38, "maximum": 68.5964, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 77.49, "10th_percentile": 38.74, "90th_percentile": 127.51, "count": "17" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.1, "median_amount": 141.45, "10th_percentile": 141.45, "90th_percentile": 141.45, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 36.8, "10th_percentile": 36.8, "90th_percentile": 58.65, "count": "1 through 10" }, { "payer_name": "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 42.76, "10th_percentile": 42.76, "90th_percentile": 64.14, "count": "11" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 50.2, "10th_percentile": 50.2, "90th_percentile": 50.2, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 105.34, "10th_percentile": 105.34, "90th_percentile": 164.62, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 42.55, "10th_percentile": 38.72, "90th_percentile": 77.44, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 38.72, "10th_percentile": 19.55, "90th_percentile": 39.1, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL L1685) POST-OP HIP ABDUCT CUSTOM FA", "code_information": [ { "code": "L1685", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1822.48, "maximum": 1822.48, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1822.48, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC IMMUNE COMPLEX ASSAY", "code_information": [ { "code": "86332", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 347.19, "discounted_cash": 100.0, "minimum": 24.37, "maximum": 314.9013, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 201.19 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 246.53 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 197.23 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 246.53 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 246.53 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 225.92 }, { "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" } ] } ] }, { "description": "Pegfilgrastim-apgf Soln Prefilled Syringe 6 MG/0.6ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00069032401", "type": "NDC" }, { "code": "Q5122", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 422.8875, "maximum": 630.68, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 630.68 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 504.54 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 630.68 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 630.68 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 422.89 } ] } ] }, { "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": 740.0, "minimum": 740.4077, "maximum": 2315.6889, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 } ] } ] }, { "description": "HC IMAG,ACUTE VENOUS THRMBSIS,UNILAT", "code_information": [ { "code": "78457", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1004.38, "discounted_cash": 291.0, "minimum": 291.2702, "maximum": 1004.38, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 593.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 727.55 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 582.04 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 727.55 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 727.55 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1004.38 } ] } ] }, { "description": "POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC", "code_information": [ { "code": "862", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11208.0, "minimum": 11208.7, "maximum": 21499.56, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 11208.7, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 15599.36, "10th_percentile": 15599.36, "90th_percentile": 15599.36, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21499.56 } ] } ] }, { "description": "Lidocaine HCl (Cardiac) IV Soln 100 MG/5ML (2%)", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "00409132315", "type": "NDC" }, { "code": "J2003", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 12.77, "10th_percentile": 12.77, "90th_percentile": 13.54, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC MRI ABDOMEN WO CONTRAST", "code_information": [ { "code": "74181", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1936.56, "discounted_cash": 561.0, "minimum": 561.6024, "maximum": 1756.4599, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1725.03 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1380.01 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1725.03 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1725.03 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1125.11 } ] } ] }, { "description": "Levothyroxine Sodium For IV Inj 100 MCG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "63323064907", "type": "NDC" }, { "code": "J0650", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 22.869, "maximum": 34.11, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 34.11 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 27.28 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 34.11 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 34.11 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.87 } ] } ] }, { "description": "UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC", "code_information": [ { "code": "737", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8294.0, "minimum": 8294.44, "maximum": 24292.37, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24292.37 } ] } ] }, { "description": "MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "810", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5828.0, "minimum": 5828.52, "maximum": 12338.35, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12338.35 } ] } ] }, { "description": "PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITH MCC", "code_information": [ { "code": "250", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6949.0, "minimum": 6949.39, "maximum": 25729.45, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25729.45 } ] } ] }, { "description": "TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC", "code_information": [ { "code": "085", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10312.0, "minimum": 10312.0, "maximum": 26783.38, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26783.38 } ] } ] }, { "description": "LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC", "code_information": [ { "code": "823", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22641.0, "minimum": 22641.57, "maximum": 54050.12, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 54050.12 } ] } ] }, { "description": "HC SARS-COV-2 COVID-19 AMP PRB", "code_information": [ { "code": "87635", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 182.5, "discounted_cash": 52.0, "minimum": 51.31, "maximum": 182.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 112.13, "10th_percentile": 112.13, "90th_percentile": 112.13, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 47.78, "10th_percentile": 47.78, "90th_percentile": 47.78, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 182.5 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 35.92, "10th_percentile": 35.92, "90th_percentile": 35.92, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 44.08, "10th_percentile": 44.08, "90th_percentile": 46.84, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 46.72, "10th_percentile": 44.08, "90th_percentile": 46.72, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 46.72, "10th_percentile": 46.72, "90th_percentile": 46.72, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 44.08, "10th_percentile": 44.08, "90th_percentile": 44.08, "count": "1 through 10" } ] } ] }, { "description": "HC CT SCAN,MAXILLOFACIAL AREA,W/O CONTRAST", "code_information": [ { "code": "70486", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1417.19, "discounted_cash": 410.0, "minimum": 410.9851, "maximum": 1285.3913, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 828.86, "10th_percentile": 828.86, "90th_percentile": 828.86, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 385.02, "10th_percentile": 385.02, "90th_percentile": 385.02, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 963.52 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 358.51, "10th_percentile": 358.51, "90th_percentile": 358.51, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 770.82 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 963.52 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 963.52 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 772.59 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 350.64, "10th_percentile": 350.64, "90th_percentile": 350.64, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1095.75, "10th_percentile": 1033.75, "90th_percentile": 1133.75, "count": "16" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 350.64, "10th_percentile": 342.24, "90th_percentile": 362.8, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 993.85, "10th_percentile": 993.85, "90th_percentile": 1028.31, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 342.24, "10th_percentile": 330.8, "90th_percentile": 395.72, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 351.48, "10th_percentile": 350.64, "90th_percentile": 363.63, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 350.64, "10th_percentile": 350.64, "90th_percentile": 362.8, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL A6229) GAUZE >16<=48 SQ IN WATR/SAL", "code_information": [ { "code": "A6229", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 5.13, "maximum": 5.13, "payers_information": [ { "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" } ] } ] }, { "description": "HC (SUP SHELL Q4138) BIODFENCE DRYFLEX, 1CM", "code_information": [ { "code": "Q4138", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 296.919, "maximum": 3168.29, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3168.29 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 442.77 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 354.21 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 442.77 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 442.77 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 296.92 } ] } ] }, { "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, "minimum": 33.0774, "maximum": 1060.8233, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 478.13 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 443.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 478.13 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 478.13 }, { "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": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 173.49, "10th_percentile": 173.49, "90th_percentile": 173.49, "count": "1 through 10" }, { "payer_name": "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 432.75, "10th_percentile": 164.25, "90th_percentile": 1052.5, "count": "14" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 95.76, "10th_percentile": 95.76, "90th_percentile": 95.76, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 363.48, "10th_percentile": 363.48, "90th_percentile": 375.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 132.48, "10th_percentile": 132.48, "90th_percentile": 257.04, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 132.77, "10th_percentile": 132.77, "90th_percentile": 337.54, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 55.85, "10th_percentile": 55.85, "90th_percentile": 55.85, "count": "1 through 10" } ] } ] }, { "description": "HC ASSAY OF SOMATOMEDIN", "code_information": [ { "code": "84305", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 255.0, "discounted_cash": 73.0, "minimum": 21.26, "maximum": 231.285, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 73.44, "10th_percentile": 73.44, "90th_percentile": 73.44, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 139.52 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 170.96 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 136.77 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 170.96 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 170.96 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 197.09 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 204.0, "10th_percentile": 204.0, "90th_percentile": 204.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 65.28, "10th_percentile": 65.28, "90th_percentile": 65.28, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 75.48, "10th_percentile": 75.48, "90th_percentile": 75.48, "count": "1 through 10" } ] } ] }, { "description": "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": 1.76, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 62.35, "10th_percentile": 62.35, "90th_percentile": 62.35, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.76 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "PREMATURITY WITHOUT MAJOR PROBLEMS", "code_information": [ { "code": "792", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19278.0, "minimum": 19278.96, "maximum": 28873.57, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28873.57 } ] } ] }, { "description": "MAJOR BLADDER PROCEDURES WITH CC", "code_information": [ { "code": "654", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11432.0, "minimum": 11432.87, "maximum": 33000.89, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 33000.89 } ] } ] }, { "description": "URETHRAL PROCEDURES WITH CCMCC", "code_information": [ { "code": "671", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8742.0, "minimum": 8742.79, "maximum": 21161.22, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21161.22 } ] } ] }, { "description": "HC ASSAY, THREE CATECHOLAMINES", "code_information": [ { "code": "82384", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 313.44, "discounted_cash": 90.0, "minimum": 25.25, "maximum": 284.2901, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 208.43 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 255.4 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 204.32 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 255.4 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 255.4 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 234.08 }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 311.0, "10th_percentile": 311.0, "90th_percentile": 311.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 80.24, "10th_percentile": 80.24, "90th_percentile": 99.52, "count": "1 through 10" } ] } ] }, { "description": "INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CCMCC", "code_information": [ { "code": "022", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3810.0, "minimum": 3810.96, "maximum": 37458.31, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 37458.31 } ] } ] }, { "description": "HC (SUP SHELL L0120) CERV FLEX N/ADJ FOAM PRE OTS", "code_information": [ { "code": "L0120", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 30.5, "maximum": 30.5, "payers_information": [ { "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" } ] } ] }, { "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": 70.0, "minimum": 70.4149, "maximum": 242.81, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 242.81 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 242.81 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 242.81 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 242.81 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 242.81 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 242.81 }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 194.25, "10th_percentile": 194.25, "90th_percentile": 194.25, "count": "1 through 10" } ] } ] }, { "description": "ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY", "code_information": [ { "code": "770", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4259.0, "minimum": 4259.31, "maximum": 11820.81, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11820.81 } ] } ] }, { "description": "OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC", "code_information": [ { "code": "315", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5828.0, "minimum": 5828.52, "maximum": 11356.32, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 5828.52, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 6431.46, "10th_percentile": 6431.46, "90th_percentile": 6431.46, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11356.32 } ] } ] }, { "description": "Atropine Sulfate Inj 0.4 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00517100401", "type": "NDC" }, { "code": "J0461", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.04, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.04 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "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": 214.0, "minimum": 214.9625, "maximum": 672.3138, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 87.75, "10th_percentile": 79.11, "90th_percentile": 213.48, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 156.1, "10th_percentile": 143.43, "90th_percentile": 379.76, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 84.54, "10th_percentile": 76.21, "90th_percentile": 205.65, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.1, "median_amount": 180.2, "10th_percentile": 180.2, "90th_percentile": 180.2, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 176.04, "10th_percentile": 176.04, "90th_percentile": 176.04, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 60.58, "10th_percentile": 55.21, "90th_percentile": 172.34, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 243.75, "10th_percentile": 219.75, "90th_percentile": 593.0, "count": "13" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 78.0, "10th_percentile": 70.32, "90th_percentile": 189.76, "count": "12" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 221.08, "10th_percentile": 175.65, "90th_percentile": 221.08, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 15.6, "10th_percentile": 15.6, "90th_percentile": 299.43, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 78.0, "10th_percentile": 78.0, "90th_percentile": 189.76, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 78.0, "10th_percentile": 74.72, "90th_percentile": 189.76, "count": "1 through 10" } ] } ] }, { "description": "SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS", "code_information": [ { "code": "029", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10536.0, "minimum": 10536.18, "maximum": 40219.28, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 40219.28 } ] } ] }, { "description": "HC (SUP SHELL L0170) CERVICAL COLLAR MOLDED TO PT", "code_information": [ { "code": "L0170", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 945.02, "maximum": 945.02, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 945.02, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC C-REACTIVE PROTEIN", "code_information": [ { "code": "86140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 147.81, "discounted_cash": 42.0, "minimum": 5.18, "maximum": 134.0637, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 79.83, "10th_percentile": 79.83, "90th_percentile": 90.82, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 40.14, "10th_percentile": 40.14, "90th_percentile": 42.57, "count": "40" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 42.74 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 52.37 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 41.01, "10th_percentile": 38.67, "90th_percentile": 41.01, "count": "43" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 41.89 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 52.37 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 52.37 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 75.33, "10th_percentile": 75.33, "90th_percentile": 75.33, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 89.32, "10th_percentile": 89.32, "90th_percentile": 92.94, "count": "11" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 48.02 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 111.5, "10th_percentile": 42.48, "90th_percentile": 118.25, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 27.49, "10th_percentile": 27.49, "90th_percentile": 27.49, "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 118.25, "10th_percentile": 111.5, "90th_percentile": 118.25, "count": "150" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 37.84, "10th_percentile": 35.68, "90th_percentile": 37.84, "count": "75" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 107.25, "10th_percentile": 102.13, "90th_percentile": 107.25, "count": "17" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 37.84, "10th_percentile": 35.68, "90th_percentile": 41.26, "count": "72" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 37.84, "10th_percentile": 35.68, "90th_percentile": 37.91, "count": "15" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 37.84, "10th_percentile": 35.68, "90th_percentile": 37.91, "count": "35" } ] } ] }, { "description": "HC CANDIDA DNA DIR PROBE", "code_information": [ { "code": "87480", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 81.88, "discounted_cash": 23.0, "minimum": 20.05, "maximum": 81.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 44.21, "10th_percentile": 44.21, "90th_percentile": 44.21, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 23.58, "10th_percentile": 22.23, "90th_percentile": 23.58, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 81.88 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 81.88 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 22.72, "10th_percentile": 22.72, "90th_percentile": 22.72, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 81.88 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 81.88 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 81.88 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 39.33, "10th_percentile": 39.33, "90th_percentile": 41.72, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 51.48, "10th_percentile": 49.47, "90th_percentile": 51.48, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 81.88 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 24.06, "10th_percentile": 24.06, "90th_percentile": 24.06, "count": "1 through 10" }, { "payer_name": "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 65.5, "10th_percentile": 61.75, "90th_percentile": 65.5, "count": "127" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 20.96, "10th_percentile": 19.76, "90th_percentile": 20.96, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 59.41, "10th_percentile": 52.35, "90th_percentile": 59.41, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 19.76, "10th_percentile": 19.76, "90th_percentile": 20.96, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 20.96, "10th_percentile": 20.96, "90th_percentile": 21.0, "count": "1 through 10" } ] } ] }, { "description": "HC ASSAY OF URIC ACID, BLOOD, OTHER SOURCE", "code_information": [ { "code": "84560", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 154.69, "discounted_cash": 44.0, "minimum": 5.08, "maximum": 140.3038, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 39.18 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 48.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 38.4 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 48.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 48.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 47.09 }, { "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": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 112.24, "10th_percentile": 112.24, "90th_percentile": 112.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 5.08, "10th_percentile": 5.08, "90th_percentile": 5.08, "count": "1 through 10" } ] } ] }, { "description": "FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC", "code_information": [ { "code": "562", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9191.0, "minimum": 9191.13, "maximum": 16796.94, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16796.94 } ] } ] }, { "description": "HC X-RAY THORACIC SPINE 4 VW", "code_information": [ { "code": "72074", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 800.94, "discounted_cash": 232.0, "minimum": 132.99, "maximum": 726.4526, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 135.67 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 166.24 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 132.99 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 166.24 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 166.24 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 279.18 } ] } ] }, { "description": "HC HSV, DNA, AMP PROBE", "code_information": [ { "code": "87529", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 332.81, "discounted_cash": 96.0, "minimum": 35.09, "maximum": 325.3018, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 214.99 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 263.43 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 210.75 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 263.43 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 263.43 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 325.3 }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 251.25, "10th_percentile": 251.25, "90th_percentile": 251.25, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 241.49, "10th_percentile": 241.49, "90th_percentile": 241.49, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL L4350) ANKLE CONTROL ORTHO PRE OTS", "code_information": [ { "code": "L4350", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 119.33, "maximum": 119.33, "payers_information": [ { "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" } ] } ] }, { "description": "HC THYROGLOBULIN ANTIBODY", "code_information": [ { "code": "86800", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 238.44, "discounted_cash": 69.0, "minimum": 15.91, "maximum": 216.2651, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 64.8, "10th_percentile": 64.8, "90th_percentile": 68.67, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 115.1 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 141.03 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 66.16, "10th_percentile": 66.16, "90th_percentile": 66.16, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 112.83 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 141.03 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 141.03 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 147.49 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 15.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 180.0, "10th_percentile": 180.0, "90th_percentile": 190.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 57.6, "10th_percentile": 57.6, "90th_percentile": 61.04, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 173.01, "10th_percentile": 173.01, "90th_percentile": 173.01, "count": "1 through 10" } ] } ] }, { "description": "INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC", "code_information": [ { "code": "064", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9863.0, "minimum": 9863.66, "maximum": 23707.64, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23707.64 } ] } ] }, { "description": "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": 729.0, "minimum": 650.0, "maximum": 2281.3862, "payers_information": [ { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1689.29 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1328.14 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 605.44, "10th_percentile": 605.44, "90th_percentile": 605.44, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1689.29 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1351.43 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1689.29 } ] } ] }, { "description": "HC US EXAM, HYSTEROSONOGRAPHY", "code_information": [ { "code": "76831", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1096.56, "discounted_cash": 318.0, "minimum": 318.0024, "maximum": 994.5799, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 339.89 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 416.49 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 333.19 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 416.49 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 416.49 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 696.51 } ] } ] }, { "description": "INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH CC", "code_information": [ { "code": "758", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8070.0, "minimum": 8070.26, "maximum": 11541.41, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11541.41 } ] } ] }, { "description": "OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC", "code_information": [ { "code": "579", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16813.0, "minimum": 16813.05, "maximum": 38178.61, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 38178.61 } ] } ] }, { "description": "HC (SUP SHELL A6452) HIGH COMPRES BAND W>=3<5YD - A6452 - 27100027", "code_information": [ { "code": "A6452", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 8.4, "maximum": 8.4, "payers_information": [ { "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" } ] } ] }, { "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", "minimum": 3.46, "maximum": 3.46, "payers_information": [ { "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" } ] } ] }, { "description": "HC IMMUNOASSAY,INFECT AGENT,QUANT", "code_information": [ { "code": "86317", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 131.25, "discounted_cash": 38.0, "minimum": 14.99, "maximum": 131.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 123.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 131.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 121.31 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 131.25 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 131.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 131.25 }, { "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" } ] } ] }, { "description": "MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC", "code_information": [ { "code": "058", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10312.0, "minimum": 10312.0, "maximum": 20153.26, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20153.26 } ] } ] }, { "description": "HC PERCUT TRANSHEPAT DILAT,BILE DUCT STRICT", "code_information": [ { "code": "74363", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2185.0, "discounted_cash": 633.0, "minimum": 334.61, "maximum": 1981.795, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 341.35 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 418.27 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 334.61 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 418.27 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 418.27 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 640.1 } ] } ] }, { "description": "HC CT SCAN DORSAL SP COMBO", "code_information": [ { "code": "72130", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2169.38, "discounted_cash": 629.0, "minimum": 629.1202, "maximum": 1967.6277, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1691.07 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1352.85 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1691.07 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1691.07 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1220.99 } ] } ] }, { "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": 32.0, "minimum": 30.68, "maximum": 102.8901, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "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" } ] } ] }, { "description": "RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS", "code_information": [ { "code": "207", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 28021.0, "minimum": 28021.75, "maximum": 75858.55, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 75858.55 } ] } ] }, { "description": "SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITH CCMCC", "code_information": [ { "code": "537", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7397.0, "minimum": 7397.74, "maximum": 11250.22, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11250.22 } ] } ] }, { "description": "HC ENTEROVIRUS, ANTIBODY", "code_information": [ { "code": "86658", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 339.69, "discounted_cash": 98.0, "minimum": 13.03, "maximum": 308.0988, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 86.15 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 105.57 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 84.45 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 105.57 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 105.57 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 120.79 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "100.00% 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": 119.0, "minimum": 119.625, "maximum": 374.1375, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 575.66, "10th_percentile": 472.56, "90th_percentile": 575.66, "count": "42" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 133.68, "10th_percentile": 133.68, "90th_percentile": 133.68, "count": "1 through 10" } ] } ] }, { "description": "HC PHOSPHOLIPID NEUTRALIZATION,PLATELET", "code_information": [ { "code": "85597", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 207.19, "discounted_cash": 60.0, "minimum": 17.98, "maximum": 187.9213, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 38.55 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 47.24 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 57.49, "10th_percentile": 57.49, "90th_percentile": 57.49, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 37.79 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 47.24 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 47.24 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 166.68 }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 156.25, "10th_percentile": 156.25, "90th_percentile": 156.25, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL A6260) WOUND CLEANSER ANY TYPE/SIZE", "code_information": [ { "code": "A6260", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "FOOT PROCEDURES WITH CC", "code_information": [ { "code": "504", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10087.0, "minimum": 10087.83, "maximum": 22035.96, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22035.96 } ] } ] }, { "description": "HC (SUP SHELL A4623) TRACHEOSTOMY INNER CANNULA", "code_information": [ { "code": "A4623", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 9.34, "maximum": 9.34, "payers_information": [ { "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" } ] } ] }, { "description": "Natalizumab for IV Inj Conc 300 MG/15ML", "drug_information": { "unit": 15.0, "type": "ML" }, "code_information": [ { "code": "64406000801", "type": "NDC" }, { "code": "J2323", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 76.7655, "maximum": 292.48, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 292.48 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 114.49 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 91.59 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 114.49 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 114.49 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 76.77 } ] } ] }, { "description": "HC DIFFUSING CAPACITY", "code_information": [ { "code": "94729", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 363.75, "discounted_cash": 105.0, "minimum": 105.4875, "maximum": 329.9212, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 104.76, "10th_percentile": 99.81, "90th_percentile": 104.76, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 186.36, "10th_percentile": 180.96, "90th_percentile": 186.36, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 100.92, "10th_percentile": 96.16, "90th_percentile": 100.92, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.1, "median_amount": 227.35, "10th_percentile": 227.35, "90th_percentile": 227.35, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 222.11, "10th_percentile": 222.11, "90th_percentile": 222.11, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 277.25, "10th_percentile": 1.14, "90th_percentile": 291.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 291.0, "10th_percentile": 277.25, "90th_percentile": 291.0, "count": "14" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 93.12, "10th_percentile": 88.72, "90th_percentile": 93.12, "count": "13" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 263.94, "10th_percentile": 221.61, "90th_percentile": 263.94, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 391.18, "10th_percentile": 88.72, "90th_percentile": 422.05, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 93.12, "10th_percentile": 93.12, "90th_percentile": 93.12, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 93.12, "10th_percentile": 93.12, "90th_percentile": 93.12, "count": "1 through 10" } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA", "code_information": [ { "code": "894", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4483.0, "minimum": 4483.48, "maximum": 7272.62, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7272.62 } ] } ] }, { "description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC", "code_information": [ { "code": "477", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19278.0, "minimum": 19278.96, "maximum": 40726.21, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 40726.21 } ] } ] }, { "description": "HC BILIRUBIN DIRECT", "code_information": [ { "code": "82248", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 47.19, "discounted_cash": 13.0, "minimum": 5.02, "maximum": 47.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 27.03, "10th_percentile": 27.03, "90th_percentile": 27.03, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 13.59, "10th_percentile": 13.59, "90th_percentile": 13.59, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 41.44 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 47.19 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 13.1, "10th_percentile": 13.1, "90th_percentile": 13.1, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 40.62 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 47.19 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 47.19 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 30.24, "10th_percentile": 29.67, "90th_percentile": 30.24, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 46.54 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 37.75, "10th_percentile": 37.75, "90th_percentile": 37.75, "count": "1 through 10" }, { "payer_name": "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 37.75, "10th_percentile": 37.75, "90th_percentile": 37.75, "count": "49" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 12.08, "10th_percentile": 12.08, "90th_percentile": 12.08, "count": "20" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 34.24, "10th_percentile": 30.17, "90th_percentile": 34.58, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 12.08, "10th_percentile": 12.08, "90th_percentile": 12.08, "count": "16" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 12.08, "10th_percentile": 12.08, "90th_percentile": 12.84, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 12.08, "10th_percentile": 12.08, "90th_percentile": 12.08, "count": "1 through 10" } ] } ] }, { "description": "SALIVARY GLAND PROCEDURES", "code_information": [ { "code": "139", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4483.0, "minimum": 4483.48, "maximum": 14567.64, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14567.64 } ] } ] }, { "description": "HC BETA 2 GLYCOPROTEIN I ANTIBODY,EA", "code_information": [ { "code": "86146", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 139.38, "discounted_cash": 40.0, "minimum": 25.45, "maximum": 139.38, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 113.46 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 139.02 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 111.22 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 139.02 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 139.02 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 139.38 }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 334.5, "10th_percentile": 111.5, "90th_percentile": 334.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 37.84, "10th_percentile": 37.84, "90th_percentile": 37.84, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 35.68, "10th_percentile": 35.68, "90th_percentile": 35.68, "count": "1 through 10" } ] } ] }, { "description": "HC ARC RBC ANTIBODY SCREEN", "code_information": [ { "code": "86850", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 208.44, "discounted_cash": 60.0, "minimum": 60.4476, "maximum": 189.0551, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 129.23, "10th_percentile": 129.23, "90th_percentile": 129.23, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 60.03, "10th_percentile": 60.03, "90th_percentile": 60.03, "count": "11" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 106.79, "10th_percentile": 106.79, "90th_percentile": 106.79, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 57.83, "10th_percentile": 57.83, "90th_percentile": 57.83, "count": "13" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 106.22, "10th_percentile": 106.22, "90th_percentile": 106.22, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 90.57 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 166.75, "10th_percentile": 166.75, "90th_percentile": 166.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 166.75, "10th_percentile": 166.75, "90th_percentile": 166.75, "count": "31" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 53.36, "10th_percentile": 53.36, "90th_percentile": 53.36, "count": "28" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 151.24, "10th_percentile": 133.28, "90th_percentile": 151.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 53.36, "10th_percentile": 53.36, "90th_percentile": 53.36, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 53.36, "10th_percentile": 53.36, "90th_percentile": 56.7, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 53.36, "10th_percentile": 53.36, "90th_percentile": 56.7, "count": "1 through 10" } ] } ] }, { "description": "MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH CC", "code_information": [ { "code": "755", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7173.0, "minimum": 7173.57, "maximum": 12824.05, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12824.05 } ] } ] }, { "description": "VAGINAL DELIVERY WITH STERILIZATION ANDOR D&C WITH CC", "code_information": [ { "code": "797", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5604.0, "minimum": 5604.35, "maximum": 11793.7, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11793.7 } ] } ] }, { "description": "HC (SUP SHELL L3912) HFO FLEXION GLOVE PRE OTS", "code_information": [ { "code": "L3912", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 106.64, "maximum": 106.64, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 106.64, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CCMCC", "code_information": [ { "code": "760", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6276.0, "minimum": 6276.87, "maximum": 11877.4, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11877.4 } ] } ] }, { "description": "HC CT SCAN OF LEG COMBO", "code_information": [ { "code": "73702", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2044.06, "discounted_cash": 592.0, "minimum": 592.7774, "maximum": 1853.9624, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1691.07 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1352.85 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1691.07 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1691.07 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1215.32 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 523.28, "10th_percentile": 523.28, "90th_percentile": 523.28, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL L8642) HALLUX IMPLANT", "code_information": [ { "code": "L8642", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 347.59, "maximum": 347.59, "payers_information": [ { "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" } ] } ] }, { "description": "HC (SUP SHELL A6236) HYDROCOLLD DRG > 48 IN W/O B", "code_information": [ { "code": "A6236", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 38.83, "maximum": 38.83, "payers_information": [ { "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" } ] } ] }, { "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": 2234.0, "minimum": 2234.9024, "maximum": 6989.8499, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3121.49 } ] } ] }, { "description": "Fosphenytoin Sodium Inj 100 MG/2ML (Phenytoin Equiv)", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "00641613625", "type": "NDC" }, { "code": "Q2009", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 8.7885, "maximum": 72.04, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 72.04 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.11 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 10.49 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 13.11 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 13.11 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.79 } ] } ] }, { "description": "OTHER O.R. PROCEDURES FOR INJURIES WITH CC", "code_information": [ { "code": "908", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8070.0, "minimum": 8070.26, "maximum": 23521.37, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23521.37 } ] } ] }, { "description": "HC SPECIAL STAINS,GROUP I", "code_information": [ { "code": "88312", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 444.69, "discounted_cash": 128.0, "minimum": 128.9601, "maximum": 444.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 47.16, "10th_percentile": 47.16, "90th_percentile": 47.16, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 83.9, "10th_percentile": 83.9, "90th_percentile": 85.51, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 444.69 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 262.0, "10th_percentile": 262.0, "90th_percentile": 262.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 262.0, "10th_percentile": 262.0, "90th_percentile": 262.0, "count": "1 through 10" } ] } ] }, { "description": "HC BILIRUBIN TOTAL", "code_information": [ { "code": "82247", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 166.88, "discounted_cash": 48.0, "minimum": 5.02, "maximum": 151.3602, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 42.72, "10th_percentile": 42.72, "90th_percentile": 42.72, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 13.36, "10th_percentile": 13.36, "90th_percentile": 42.72, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 42.72, "10th_percentile": 42.72, "90th_percentile": 42.72, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 41.44 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 50.77 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 14.48, "10th_percentile": 14.48, "90th_percentile": 14.48, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 40.62 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 50.77 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 50.77 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 85.04, "10th_percentile": 85.04, "90th_percentile": 85.04, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 106.95, "10th_percentile": 106.95, "90th_percentile": 106.95, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 46.54 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 131.86, "10th_percentile": 131.86, "90th_percentile": 131.86, "count": "1 through 10" }, { "payer_name": "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 50.0, "10th_percentile": 41.75, "90th_percentile": 133.5, "count": "15" } ] } ] }, { "description": "HC HETEROPHILE ANTIBODIES,SCREEN", "code_information": [ { "code": "86308", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 118.44, "discounted_cash": 34.0, "minimum": 5.18, "maximum": 107.4251, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 69.36, "10th_percentile": 69.36, "90th_percentile": 69.36, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 42.74 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 52.37 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 41.89 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 52.37 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 52.37 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 75.89, "10th_percentile": 75.89, "90th_percentile": 77.7, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 48.02 }, { "payer_name": "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 94.75, "10th_percentile": 89.5, "90th_percentile": 94.75, "count": "20" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 30.32, "10th_percentile": 30.32, "90th_percentile": 30.32, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 30.32, "10th_percentile": 30.32, "90th_percentile": 30.32, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 30.32, "10th_percentile": 30.32, "90th_percentile": 30.32, "count": "1 through 10" } ] } ] }, { "description": "Protamine Sulfate Inj 10 MG/ML", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "63323022901", "type": "NDC" }, { "code": "J2720", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 4.41, "maximum": 16.91, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.91 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.58 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.26 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 6.58 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 6.58 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.41 } ] } ] }, { "description": "UNCOMPLICATED PEPTIC ULCER WITHOUT MCC", "code_information": [ { "code": "384", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5380.0, "minimum": 5380.18, "maximum": 10077.22, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10077.22 } ] } ] }, { "description": "ENDOCRINE DISORDERS WITH MCC", "code_information": [ { "code": "643", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10984.0, "minimum": 10984.53, "maximum": 19405.84, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19405.84 } ] } ] }, { "description": "INTRAOCULAR PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "117", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4259.0, "minimum": 4259.31, "maximum": 12789.86, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12789.86 } ] } ] }, { "description": "HC US GUIDE AMNIOCENTESIS", "code_information": [ { "code": "76946", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1071.56, "discounted_cash": 310.0, "minimum": 104.4, "maximum": 971.9049, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 106.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 130.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 104.4 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 130.5 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 130.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 129.69 } ] } ] }, { "description": "HC X-RAY SALIVARY GLAND", "code_information": [ { "code": "70380", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 916.88, "discounted_cash": 265.0, "minimum": 110.11, "maximum": 831.6102, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 112.33 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 137.64 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 110.11 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 137.64 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 137.64 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 250.97 } ] } ] }, { "description": "HC DOPPLER FETAL UMBILICAL ARTERY", "code_information": [ { "code": "76820", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 516.56, "discounted_cash": 149.0, "minimum": 118.68, "maximum": 468.5199, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 121.06 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 148.35 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 118.68 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 148.35 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 148.35 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 180.5 } ] } ] }, { "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": 553.0, "minimum": 553.9, "maximum": 1744.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 1032.11, "10th_percentile": 1032.11, "90th_percentile": 1032.11, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 550.08, "10th_percentile": 518.94, "90th_percentile": 550.08, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1744.7 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 249.91, "10th_percentile": 249.91, "90th_percentile": 529.91, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1395.75 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1744.7 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1744.7 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 1154.79, "10th_percentile": 1154.79, "90th_percentile": 1201.01, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1703.13 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1528.0, "10th_percentile": 1441.5, "90th_percentile": 1528.0, "count": "23" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 461.28, "10th_percentile": 461.28, "90th_percentile": 488.96, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 1385.9, "10th_percentile": 1320.41, "90th_percentile": 1399.65, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 488.96, "10th_percentile": 461.28, "90th_percentile": 488.96, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 488.96, "10th_percentile": 461.28, "90th_percentile": 488.96, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 488.96, "10th_percentile": 461.28, "90th_percentile": 488.96, "count": "1 through 10" } ] } ] }, { "description": "ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS WITH PRINCIPAL DIAGNOSIS PULMONARY EMBOLISM", "code_information": [ { "code": "173", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8518.0, "minimum": 8518.61, "maximum": 35088.72, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 35088.72 } ] } ] }, { "description": "HC (SUP SHELL A6253) ABSORPT DRG > 48 SQ IN W/O B - A6253 - 27200142", "code_information": [ { "code": "A6253", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 9.03, "maximum": 9.03, "payers_information": [ { "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" } ] } ] }, { "description": "HC HPV HIGH-RISK TYPES", "code_information": [ { "code": "87624", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 220.31, "discounted_cash": 63.0, "minimum": 35.09, "maximum": 220.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 119.04, "10th_percentile": 119.04, "90th_percentile": 119.04, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 59.85, "10th_percentile": 59.85, "90th_percentile": 63.45, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 200.4 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 220.31 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 61.13, "10th_percentile": 61.13, "90th_percentile": 61.13, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 196.45 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 220.31 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 220.31 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 112.27, "10th_percentile": 105.9, "90th_percentile": 112.27, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 138.53, "10th_percentile": 133.18, "90th_percentile": 138.53, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 220.31 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 55.35, "10th_percentile": 55.35, "90th_percentile": 103.04, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 38.64, "10th_percentile": 38.08, "90th_percentile": 42.11, "count": "1 through 10" }, { "payer_name": "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 176.25, "10th_percentile": 166.25, "90th_percentile": 176.25, "count": "104" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 53.2, "10th_percentile": 35.09, "90th_percentile": 56.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 152.28, "10th_percentile": 140.88, "90th_percentile": 159.86, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 56.4, "10th_percentile": 53.2, "90th_percentile": 56.4, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 53.2, "10th_percentile": 53.2, "90th_percentile": 56.4, "count": "1 through 10" } ] } ] }, { "description": "HC COMPATIBILITY TEST, ELECTRONIC", "code_information": [ { "code": "86923", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 96.25, "discounted_cash": 27.0, "minimum": 27.9125, "maximum": 96.25, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 96.25 } ] } ] }, { "description": "HC IMMUNOASSAY, TUMOR ANTIGEN, QUANT", "code_information": [ { "code": "86316", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 220.94, "discounted_cash": 64.0, "minimum": 20.81, "maximum": 210.44, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 171.74 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 210.44 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 168.35 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 210.44 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 210.44 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 192.92 }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 166.75, "10th_percentile": 166.75, "90th_percentile": 176.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 56.56, "10th_percentile": 56.56, "90th_percentile": 56.7, "count": "1 through 10" } ] } ] }, { "description": "LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "822", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3362.0, "minimum": 3362.61, "maximum": 14193.93, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14193.93 } ] } ] }, { "description": "Digoxin Inj 0.25 MG/ML", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "00641141031", "type": "NDC" }, { "code": "J1160", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 15.372, "maximum": 102.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 102.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.93 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 18.34 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 22.93 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 22.93 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.37 } ] } ] }, { "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": 1.0, "payers_information": [ { "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" } ] } ] }, { "description": "HC (SUP SHELL C1717) BRACHYTX, NON-STR,HDR IR-192", "code_information": [ { "code": "C1717", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1078.5285, "maximum": 1078.5285, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1078.53 } ] } ] }, { "description": "HC BLOOD CLOT FACTOR XII TEST", "code_information": [ { "code": "85280", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 360.31, "discounted_cash": 104.0, "minimum": 19.35, "maximum": 326.8012, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 159.7 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 195.69 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 156.55 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 195.69 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 195.69 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 179.38 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% 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", "minimum": 12.88, "maximum": 12.88, "payers_information": [ { "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" } ] } ] }, { "description": "HC (SUP SHELL L1830) KO IMMOB CANVAS LONG PRE OTS", "code_information": [ { "code": "L1830", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 74.79, "maximum": 74.79, "payers_information": [ { "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" } ] } ] }, { "description": "HC ANGIO EXTERMITY BILAT", "code_information": [ { "code": "75716", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10259.7, "discounted_cash": 2975.0, "minimum": 609.0963, "maximum": 9305.5479, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1025.54 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1256.65 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1005.31 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1256.65 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1256.65 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 609.1 } ] } ] }, { "description": "HC RENAL IMAGING WITH FLOW", "code_information": [ { "code": "78701", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 788.13, "discounted_cash": 228.0, "minimum": 228.5577, "maximum": 788.13, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 717.73 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 788.13 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 703.57 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 788.13 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 788.13 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 788.13 } ] } ] }, { "description": "HC SEMEN ANALYSIS, SPERM PRESENCE AND MOTILITY", "code_information": [ { "code": "89321", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 98.44, "discounted_cash": 28.0, "minimum": 12.05, "maximum": 98.44, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 98.44 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 98.44 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 97.53 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 98.44 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 98.44 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 98.44 }, { "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" } ] } ] }, { "description": "Filgrastim-sndz Soln Prefilled Syringe 300 MCG/0.5ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "61314031801", "type": "NDC" }, { "code": "Q5101", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0395, "maximum": 9.55, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.55 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.55 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.24 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.55 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.55 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.04 } ] } ] }, { "description": "POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC", "code_information": [ { "code": "917", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8294.0, "minimum": 8294.44, "maximum": 18489.84, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18489.84 } ] } ] }, { "description": "HC (SUP SHELL A4434) OST PCH URINE W LOCK FLNG/FT", "code_information": [ { "code": "A4434", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 5.36, "maximum": 5.36, "payers_information": [ { "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" } ] } ] }, { "description": "Droperidol Inj 2.5 MG/ML", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "00517970201", "type": "NDC" }, { "code": "J1790", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 26.9955, "maximum": 43.67, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 43.67 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 40.21 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 32.17 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 40.21 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 40.21 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.0 } ] } ] }, { "description": "MAJOR HEAD AND NECK PROCEDURES WITH MCC", "code_information": [ { "code": "140", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15468.0, "minimum": 15468.01, "maximum": 50283.54, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 50283.54 } ] } ] }, { "description": "HC PINWORM EXAM", "code_information": [ { "code": "87172", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 86.88, "discounted_cash": 25.0, "minimum": 4.27, "maximum": 78.8002, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 35.22 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 43.16 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 34.52 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 43.16 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 43.16 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.59 }, { "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" } ] } ] }, { "description": "SINUS AND MASTOID PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "136", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 2914.0, "minimum": 2914.26, "maximum": 11969.35, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11969.35 } ] } ] }, { "description": "HC URINE PREGNANCY TEST", "code_information": [ { "code": "81025", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 95.94, "discounted_cash": 27.0, "minimum": 8.61, "maximum": 87.0176, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 54.95, "10th_percentile": 54.95, "90th_percentile": 59.48, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 27.63, "10th_percentile": 13.86, "90th_percentile": 27.63, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 52.23 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 64.01 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 13.35, "10th_percentile": 13.35, "90th_percentile": 13.35, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 51.2 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 64.01 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 64.01 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 61.48, "10th_percentile": 61.48, "90th_percentile": 62.94, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 60.33, "10th_percentile": 60.33, "90th_percentile": 60.33, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 79.82 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 8.61, "10th_percentile": 8.61, "90th_percentile": 12.32, "count": "1 through 10" }, { "payer_name": "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 76.75, "10th_percentile": 38.5, "90th_percentile": 76.75, "count": "358" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 24.56, "10th_percentile": 8.61, "90th_percentile": 24.56, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 69.61, "10th_percentile": 61.35, "90th_percentile": 70.3, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 24.56, "10th_percentile": 24.56, "90th_percentile": 2322.17, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 12.32, "10th_percentile": 12.32, "90th_percentile": 24.56, "count": "1 through 10" } ] } ] }, { "description": "PERIPHERAL VASCULAR DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "301", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4483.0, "minimum": 4483.48, "maximum": 8484.53, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8484.53 } ] } ] }, { "description": "OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "817", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8070.0, "minimum": 8070.26, "maximum": 26897.74, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26897.74 } ] } ] }, { "description": "Oxytocin Inj 10 Unit/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "42023011625", "type": "NDC" }, { "code": "J2590", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 4.5045, "maximum": 12.92, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.92 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.72 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.37 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 6.72 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 6.72 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.5 } ] } ] }, { "description": "SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH MCC", "code_information": [ { "code": "510", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11881.0, "minimum": 11881.22, "maximum": 35608.61, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 35608.61 } ] } ] }, { "description": "HC FERN TEST - 87210 - 30600080", "code_information": [ { "code": "87210", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 88.13, "discounted_cash": 25.0, "minimum": 5.82, "maximum": 79.9339, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 47.61, "10th_percentile": 47.61, "90th_percentile": 47.61, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 35.22 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 43.16 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 34.52 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 43.16 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 43.16 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 56.47, "10th_percentile": 56.47, "90th_percentile": 56.47, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 55.41, "10th_percentile": 55.41, "90th_percentile": 55.41, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 53.95 }, { "payer_name": "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 70.5, "10th_percentile": 66.5, "90th_percentile": 70.5, "count": "39" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 22.56, "10th_percentile": 22.56, "90th_percentile": 22.56, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 22.56, "10th_percentile": 22.56, "90th_percentile": 22.56, "count": "1 through 10" } ] } ] }, { "description": "OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "581", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4707.0, "minimum": 4707.65, "maximum": 17012.68, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17012.68 } ] } ] }, { "description": "HC X-RAY TOE(S)", "code_information": [ { "code": "73660", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 370.0, "discounted_cash": 107.0, "minimum": 80.1, "maximum": 335.59, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 227.33, "10th_percentile": 227.33, "90th_percentile": 227.33, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 100.53, "10th_percentile": 100.53, "90th_percentile": 106.56, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 81.71 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 100.12 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 102.65, "10th_percentile": 102.65, "90th_percentile": 102.65, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 80.1 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 100.12 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 100.12 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 232.66, "10th_percentile": 232.66, "90th_percentile": 232.66, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 194.56 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 296.0, "10th_percentile": 279.25, "90th_percentile": 296.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 255.79, "10th_percentile": 255.79, "90th_percentile": 255.79, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 103.32, "10th_percentile": 103.32, "90th_percentile": 103.32, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 89.36, "10th_percentile": 89.36, "90th_percentile": 89.36, "count": "1 through 10" } ] } ] }, { "description": "HC ASSAY ALKALINE PHOSPHATASE ,ISOENZYMES", "code_information": [ { "code": "84080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 310.63, "discounted_cash": 90.0, "minimum": 14.78, "maximum": 281.7414, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 122.05 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 149.55 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 119.64 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 149.55 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 149.55 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 137.02 }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 248.5, "10th_percentile": 248.5, "90th_percentile": 248.5, "count": "1 through 10" } ] } ] }, { "description": "Darbepoetin Alfa Soln Prefilled Syringe 25 MCG/0.42ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "55513005704", "type": "NDC" }, { "code": "J0881", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 9.198, "maximum": 56.43, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 56.43 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.72 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 10.97 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 13.72 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 13.72 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.2 } ] } ] }, { "description": "SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH CC", "code_information": [ { "code": "457", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10760.0, "minimum": 10760.35, "maximum": 70298.87, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 70298.87 } ] } ] }, { "description": "Ketorolac Tromethamine Inj 30 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "63323016200", "type": "NDC" }, { "code": "J1885", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.575, "maximum": 8.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 12.77, "10th_percentile": 12.77, "90th_percentile": 13.54, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.4 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2.35 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.88 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2.35 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2.35 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.58 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 6.25, "10th_percentile": 6.25, "90th_percentile": 6.25, "count": "1 through 10" } ] } ] }, { "description": "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": 1.17, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 150.42, "10th_percentile": 46.15, "90th_percentile": 418.56, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.17 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.17 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.17 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION", "code_information": [ { "code": "880", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6276.0, "minimum": 2674.6518, "maximum": 11319.78, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11319.78 } ] } ] }, { "description": "CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC", "code_information": [ { "code": "415", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10312.0, "minimum": 10312.0, "maximum": 24364.28, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24364.28 } ] } ] }, { "description": "HC US GUIDE HEART BIOPSY", "code_information": [ { "code": "76932", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 860.31, "discounted_cash": 249.0, "minimum": 245.96, "maximum": 780.3012, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 250.91 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 307.45 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 245.96 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 307.45 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 307.45 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 507.55 } ] } ] }, { "description": "MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CCMCC", "code_information": [ { "code": "060", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6501.0, "minimum": 6501.05, "maximum": 10843.5, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10843.5 } ] } ] }, { "description": "HC ANTIBODY DETECTION NOS IF", "code_information": [ { "code": "87299", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 207.81, "discounted_cash": 60.0, "minimum": 16.1, "maximum": 188.4837, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 94.58 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 115.89 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 92.71 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 115.89 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 115.89 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 149.26 }, { "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" } ] } ] }, { "description": "ENDOCRINE DISORDERS WITH CC", "code_information": [ { "code": "644", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7621.0, "minimum": 7621.92, "maximum": 12083.7, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12083.7 } ] } ] }, { "description": "Levetiracetam in Sodium Chloride IV Soln 1500 MG/100ML", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "43598063752", "type": "NDC" }, { "code": "J1953", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.76, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.76 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC (SUP SHELLQ4237) CRYO-CORD, PER SQ CM", "code_information": [ { "code": "Q4237", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1337.0805, "maximum": 1994.08, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1994.08 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1595.24 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1994.08 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1994.08 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1337.08 } ] } ] }, { "description": "HC (SUP SHELL A4353) INTERMITTENT URINARY CATH", "code_information": [ { "code": "A4353", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 9.97, "maximum": 9.97, "payers_information": [ { "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" } ] } ] }, { "description": "INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC", "code_information": [ { "code": "020", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19727.0, "minimum": 19727.31, "maximum": 92765.13, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 92765.13 } ] } ] }, { "description": "HC RH IG, FULL-DOSE, IM", "code_information": [ { "code": "90384", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 512.81, "discounted_cash": 148.0, "minimum": 148.7149, "maximum": 512.81, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 512.81 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 396.92 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 317.53 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 396.92 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 396.92 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 266.14 } ] } ] }, { "description": "HC BLD CLOT FACTOR XIII, SCREEN SOLUBILITY", "code_information": [ { "code": "85291", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 155.63, "discounted_cash": 45.0, "minimum": 9.11, "maximum": 141.1564, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 73.38 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 89.91 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 71.93 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 89.91 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 89.91 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 84.45 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 9.11, "additional_payer_notes": "100.00% 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": 55.0, "minimum": 12.58, "maximum": 172.6112, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 103.85 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 127.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 101.8 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 127.25 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 127.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 116.62 }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 152.25, "10th_percentile": 152.25, "90th_percentile": 152.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 48.72, "10th_percentile": 48.72, "90th_percentile": 48.72, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 48.72, "10th_percentile": 48.72, "90th_percentile": 51.77, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL A6266) IMPREG GAUZE NO H20/SAL/YARD - A6266 - 27200151", "code_information": [ { "code": "A6266", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2.72, "maximum": 2.72, "payers_information": [ { "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" } ] } ] }, { "description": "HC VENT MANAGEMENT, INPATIENT, INITIAL DAY", "code_information": [ { "code": "94002", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1044.38, "discounted_cash": 302.0, "minimum": 302.8702, "maximum": 947.2527, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 598.22, "10th_percentile": 598.22, "90th_percentile": 598.22, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 835.5, "10th_percentile": 835.5, "90th_percentile": 835.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 267.36, "10th_percentile": 267.36, "90th_percentile": 267.36, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 267.36, "10th_percentile": 267.36, "90th_percentile": 267.36, "count": "1 through 10" } ] } ] }, { "description": "HC IGG 1 2 3 OR 4 EACH", "code_information": [ { "code": "82787", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 82.5, "discounted_cash": 23.0, "minimum": 8.02, "maximum": 74.8275, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 30.41 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 37.27 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 29.81 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 37.27 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 37.27 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 74.35 }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 249.0, "10th_percentile": 249.0, "90th_percentile": 249.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 79.68, "10th_percentile": 79.68, "90th_percentile": 92.13, "count": "1 through 10" } ] } ] }, { "description": "HC PHYS THRP RE-EVAL, 20 MIN", "code_information": [ { "code": "97164", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 316.88, "discounted_cash": 91.0, "minimum": 64.54, "maximum": 287.4102, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 64.54, "additional_payer_notes": "100.00% 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": 183.0, "minimum": 183.6077, "maximum": 574.2489, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 280.85, "10th_percentile": 280.85, "90th_percentile": 362.65, "count": "44" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 205.18, "10th_percentile": 205.18, "90th_percentile": 205.18, "count": "1 through 10" } ] } ] }, { "description": "SPINAL DISORDERS AND INJURIES WITHOUT CCMCC", "code_information": [ { "code": "053", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5828.0, "minimum": 5828.52, "maximum": 11543.77, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11543.77 } ] } ] }, { "description": "HC NM BOWEL IMAGING", "code_information": [ { "code": "78290", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1090.63, "discounted_cash": 316.0, "minimum": 316.2827, "maximum": 1090.63, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 983.27 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1090.63 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 963.88 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1090.63 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1090.63 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1090.63 } ] } ] }, { "description": "PULMONARY EMBOLISM WITHOUT MCC", "code_information": [ { "code": "176", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5380.0, "minimum": 5380.18, "maximum": 19107.63, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 5380.18, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 6431.46, "10th_percentile": 6431.46, "90th_percentile": 6431.46, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9490.13 } ] } ] }, { "description": "HC MRI BREAST WITHOUT CONTRAST MATERIAL BILATERAL", "code_information": [ { "code": "77047", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1235.31, "discounted_cash": 358.0, "minimum": 358.2399, "maximum": 1235.31, "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": 1235.31 } ] } ] }, { "description": "LIVER TRANSPLANT WITHOUT MCC", "code_information": [ { "code": "006", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15916.0, "minimum": 15916.35, "maximum": 54665.5, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 54665.5 } ] } ] }, { "description": "INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC", "code_information": [ { "code": "854", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10984.0, "minimum": 10984.53, "maximum": 23555.56, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23555.56 } ] } ] }, { "description": "SKIN GRAFTS FOR INJURIES WITH CCMCC", "code_information": [ { "code": "904", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14795.0, "minimum": 14795.48, "maximum": 43302.1, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 43302.1 } ] } ] }, { "description": "COMPLICATIONS OF TREATMENT WITH CC", "code_information": [ { "code": "920", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6276.0, "minimum": 6276.87, "maximum": 11816.09, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11816.09 } ] } ] }, { "description": "HC MRI, DORSAL SPINE", "code_information": [ { "code": "72146", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2612.81, "discounted_cash": 757.0, "minimum": 757.7149, "maximum": 2369.8187, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 752.49, "10th_percentile": 752.49, "90th_percentile": 752.49, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1725.03 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1380.01 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1725.03 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1725.03 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1068.7 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 668.88, "10th_percentile": 668.88, "90th_percentile": 668.88, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 2090.25, "10th_percentile": 2090.25, "90th_percentile": 2090.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 668.88, "10th_percentile": 668.88, "90th_percentile": 668.88, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 668.88, "10th_percentile": 668.88, "90th_percentile": 668.88, "count": "1 through 10" } ] } ] }, { "description": "HC FLUORSCOPIC GUIDANCE SPINAL INJECTION", "code_information": [ { "code": "77003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 660.94, "discounted_cash": 191.0, "minimum": 123.0, "maximum": 651.3691, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 125.47 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 153.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 123.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 153.75 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 153.75 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 651.37 } ] } ] }, { "description": "UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC", "code_information": [ { "code": "740", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5828.0, "minimum": 5828.52, "maximum": 21333.34, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21333.34 } ] } ] }, { "description": "HC ASSAY OF AMMONIA", "code_information": [ { "code": "82140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 305.94, "discounted_cash": 88.0, "minimum": 14.57, "maximum": 277.4876, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 120.3 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 147.41 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 117.93 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 147.41 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 147.41 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 135.07 }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 244.75, "10th_percentile": 244.75, "90th_percentile": 244.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 78.32, "10th_percentile": 78.32, "90th_percentile": 83.22, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 78.32, "10th_percentile": 78.32, "90th_percentile": 78.32, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 78.32, "10th_percentile": 78.32, "90th_percentile": 78.32, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL A6204) COMPOSITE DRSG >16<=48 SQ IN - A6204 - RU272042", "code_information": [ { "code": "A6204", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 8.86, "maximum": 8.86, "payers_information": [ { "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" } ] } ] }, { "description": "HC (SUP SHELL A4614) HAND-HELD PEFR METER", "code_information": [ { "code": "A4614", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 33.89, "maximum": 96.68, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 96.68 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 77.34 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 96.68 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 96.68 }, { "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" } ] } ] }, { "description": "HC X-RAY RIBS 2 VW UNILAT", "code_information": [ { "code": "71100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 533.44, "discounted_cash": 154.0, "minimum": 84.38, "maximum": 483.8301, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 86.08 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 105.47 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 84.38 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 105.47 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 105.47 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 222.77 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 426.75, "10th_percentile": 426.75, "90th_percentile": 426.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 136.85, "10th_percentile": 136.85, "90th_percentile": 136.85, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 136.56, "10th_percentile": 136.56, "90th_percentile": 136.56, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 136.56, "10th_percentile": 136.56, "90th_percentile": 136.56, "count": "1 through 10" } ] } ] }, { "description": "HC NK CELLS TOTAL COUNT", "code_information": [ { "code": "86357", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 310.63, "discounted_cash": 90.0, "minimum": 37.73, "maximum": 310.63, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 94.58 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 115.89 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 92.71 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 115.89 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 115.89 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 150.13, "10th_percentile": 150.13, "90th_percentile": 150.13, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 310.63 }, { "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" } ] } ] }, { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT WITH CCMCC", "code_information": [ { "code": "016", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 36092.0, "minimum": 36092.01, "maximum": 69905.11, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 69905.11 } ] } ] }, { "description": "HC ARTHROGRAM OF KNEE JOINT", "code_information": [ { "code": "73580", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 657.81, "discounted_cash": 190.0, "minimum": 190.7649, "maximum": 657.81, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 369.1 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 452.27 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 361.82 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 452.27 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 452.27 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 657.81 } ] } ] }, { "description": "STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC", "code_information": [ { "code": "327", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8742.0, "minimum": 8742.79, "maximum": 28814.62, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28814.62 } ] } ] }, { "description": "OTHER CARDIOTHORACIC PROCEDURES WITH MCC", "code_information": [ { "code": "228", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13674.0, "minimum": 13674.61, "maximum": 58324.8, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 58324.8 } ] } ] }, { "description": "HC CYTOPATH FLUIDS,SMEAR,INTERP", "code_information": [ { "code": "88104", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 114.38, "discounted_cash": 33.0, "minimum": 33.1702, "maximum": 114.38, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 114.38 } ] } ] }, { "description": "PROSTATECTOMY WITH MCC", "code_information": [ { "code": "665", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15916.0, "minimum": 15916.35, "maximum": 36795.76, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 36795.76 } ] } ] }, { "description": "HC WESTERN BLOT TEST", "code_information": [ { "code": "84181", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 267.81, "discounted_cash": 77.0, "minimum": 17.03, "maximum": 242.9037, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 140.59 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 172.27 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 137.82 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 172.27 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 172.27 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 157.88 }, { "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" } ] } ] }, { "description": "HC (SUP SHELL A4618) BREATHING CIRCUITS", "code_information": [ { "code": "A4618", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 12.68, "maximum": 12.68, "payers_information": [ { "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" } ] } ] }, { "description": "HC CT SCAN MAXILLOFACIAL AREA COMBO", "code_information": [ { "code": "70488", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2499.06, "discounted_cash": 724.0, "minimum": 650.0, "maximum": 2266.6474, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1689.29 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1351.43 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1689.29 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1689.29 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1096.91 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1886.0, "10th_percentile": 1886.0, "90th_percentile": 1886.0, "count": "1 through 10" } ] } ] }, { "description": "HC DETECT AGENT NOS, DNA, AMP", "code_information": [ { "code": "87798", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 345.63, "discounted_cash": 100.0, "minimum": 35.09, "maximum": 325.3018, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 619.16, "10th_percentile": 368.71, "90th_percentile": 916.42, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 214.99 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 263.43 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 299.9, "10th_percentile": 165.0, "90th_percentile": 413.82, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 210.75 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 263.43 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 263.43 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 716.94, "10th_percentile": 45.92, "90th_percentile": 716.94, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 44.86, "10th_percentile": 44.86, "90th_percentile": 797.21, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 325.3 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 59.25, "10th_percentile": 59.25, "90th_percentile": 59.25, "count": "1 through 10" }, { "payer_name": "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 56.0, "10th_percentile": 56.0, "90th_percentile": 59.25, "count": "56" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 360.16, "10th_percentile": 17.92, "90th_percentile": 381.84, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 1082.28, "10th_percentile": 107.48, "90th_percentile": 1189.76, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 18.96, "10th_percentile": 17.92, "90th_percentile": 381.84, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 88.0, "10th_percentile": 19.04, "90th_percentile": 381.84, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 381.84, "10th_percentile": 19.04, "90th_percentile": 381.84, "count": "1 through 10" } ] } ] }, { "description": "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": "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" } ] } ] }, { "description": "HC CYTOMED, DNA, AMP PROBE", "code_information": [ { "code": "87493", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 244.69, "discounted_cash": 70.0, "minimum": 37.27, "maximum": 244.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 132.28, "10th_percentile": 132.28, "90th_percentile": 143.18, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 70.47, "10th_percentile": 66.51, "90th_percentile": 70.47, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 210.92 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 244.69 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 64.08, "10th_percentile": 64.08, "90th_percentile": 67.89, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 206.76 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 244.69 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 244.69 }, { "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": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 37.27, "10th_percentile": 37.27, "90th_percentile": 59.12, "count": "1 through 10" }, { "payer_name": "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 195.75, "10th_percentile": 184.75, "90th_percentile": 195.75, "count": "11" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 37.27, "10th_percentile": 37.27, "90th_percentile": 62.64, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 62.64, "10th_percentile": 62.64, "90th_percentile": 62.64, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 62.64, "10th_percentile": 37.27, "90th_percentile": 62.82, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 62.64, "10th_percentile": 62.64, "90th_percentile": 62.64, "count": "1 through 10" } ] } ] }, { "description": "ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY", "code_information": [ { "code": "884", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10312.0, "minimum": 10312.0, "maximum": 47927.034, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18967.29 } ] } ] }, { "description": "HC ARC COLD AGGLUTININ SCREEN", "code_information": [ { "code": "86156", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 194.38, "discounted_cash": 56.0, "minimum": 8.07, "maximum": 176.3027, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 52.63 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 64.49 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 51.59 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 64.49 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 64.49 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 74.81 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L8614) COCHLEAR DEVICE", "code_information": [ { "code": "L8614", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 23439.57, "maximum": 23439.57, "payers_information": [ { "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" } ] } ] }, { "description": "HC SEMEN ANALYSIS STRICT MORPHOLOGIC CRITERIA", "code_information": [ { "code": "89322", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 384.06, "discounted_cash": 111.0, "minimum": 15.5, "maximum": 348.3424, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 127.93 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 156.76 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 125.41 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 156.76 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 156.76 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 143.69 }, { "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" } ] } ] }, { "description": "HC ASSAY, BLD/SERUM CHOLESTEROL", "code_information": [ { "code": "82465", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 60.0, "discounted_cash": 17.0, "minimum": 4.35, "maximum": 54.42, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 34.37, "10th_percentile": 34.37, "90th_percentile": 34.37, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 17.28, "10th_percentile": 17.28, "90th_percentile": 17.28, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 35.95 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 44.06 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 16.65, "10th_percentile": 16.65, "90th_percentile": 16.65, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 35.24 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 44.06 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 44.06 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 30.58, "10th_percentile": 30.58, "90th_percentile": 30.58, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.33 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 14.87, "10th_percentile": 14.87, "90th_percentile": 14.87, "count": "1 through 10" }, { "payer_name": "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 4.35, "10th_percentile": 4.35, "90th_percentile": 4.35, "count": "18" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 15.36, "10th_percentile": 15.36, "90th_percentile": 16.32, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 43.97, "10th_percentile": 43.54, "90th_percentile": 43.97, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 15.36, "10th_percentile": 15.36, "90th_percentile": 16.32, "count": "1 through 10" } ] } ] }, { "description": "Azithromycin For Susp 200 MG/5ML", "drug_information": { "unit": 15.0, "type": "ML" }, "code_information": [ { "code": "42806014932", "type": "NDC" }, { "code": "Q0144", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 79.3485, "maximum": 363.9, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 363.9 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 118.34 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 94.67 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 118.34 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 118.34 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 79.35 } ] } ] }, { "description": "KCl 20 MEQ/L (0.15%) in Dextrose 5% & NaCl 0.45% Inj", "drug_information": { "unit": 1000.0, "type": "ML" }, "code_information": [ { "code": "00990790209", "type": "NDC" }, { "code": "J3480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.76, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 62.35, "10th_percentile": 62.35, "90th_percentile": 62.35, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.76 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC", "code_information": [ { "code": "242", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10760.0, "minimum": 10760.35, "maximum": 37639.86, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 37639.86 } ] } ] }, { "description": "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": 464.0, "minimum": 121.63, "maximum": 1452.6149, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 936.61 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1147.67 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 918.13 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1147.67 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1147.67 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1127.57 }, { "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" } ] } ] }, { "description": "HC TOXOPLASMA, IGM", "code_information": [ { "code": "86778", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 170.63, "discounted_cash": 49.0, "minimum": 14.41, "maximum": 154.7614, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 118.88 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 145.67 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 116.54 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 145.67 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 145.67 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 82.01, "10th_percentile": 82.01, "90th_percentile": 82.01, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 133.59 }, { "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" } ] } ] }, { "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": 60.0, "minimum": 33.34, "maximum": 189.9077, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 162.0, "10th_percentile": 162.0, "90th_percentile": 162.0, "count": "1 through 10" }, { "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 Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 55.08, "10th_percentile": 51.84, "90th_percentile": 103.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 51.84, "10th_percentile": 51.84, "90th_percentile": 51.84, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 51.84, "10th_percentile": 51.84, "90th_percentile": 103.68, "count": "1 through 10" } ] } ] }, { "description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC", "code_information": [ { "code": "559", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11432.0, "minimum": 11432.87, "maximum": 31579.7693, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 11432.87, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 21449.12, "10th_percentile": 21449.12, "90th_percentile": 21449.12, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21985.27 } ] } ] }, { "description": "HC (SUP SHELL L1686) HO POST-OP HIP ABDUCTION", "code_information": [ { "code": "L1686", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1155.66, "maximum": 1155.66, "payers_information": [ { "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" } ] } ] }, { "description": "HC X-RAY TMJ BILAT", "code_information": [ { "code": "70330", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 771.88, "discounted_cash": 223.0, "minimum": 135.84, "maximum": 700.0952, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 138.58 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 169.81 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 135.84 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 169.81 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 169.81 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 352.46 } ] } ] }, { "description": "HC PAPPA SERUM", "code_information": [ { "code": "84163", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 250.94, "discounted_cash": 72.0, "minimum": 15.05, "maximum": 227.6026, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 121.8 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 152.26 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 152.26 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 139.52 }, { "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": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 124.26 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 152.26 } ] } ] }, { "description": "HC US, RETROPERITNL ABD, LTD", "code_information": [ { "code": "76775", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 677.81, "discounted_cash": 196.0, "minimum": 196.5649, "maximum": 614.7737, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 252.18, "10th_percentile": 252.18, "90th_percentile": 267.3, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 400.43 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 215.88, "10th_percentile": 215.88, "90th_percentile": 257.5, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 320.34 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 400.43 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 400.43 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 472.97, "10th_percentile": 472.97, "90th_percentile": 472.97, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 276.31 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 237.6, "10th_percentile": 199.2, "90th_percentile": 238.17, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 742.5, "10th_percentile": 700.5, "90th_percentile": 742.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 237.6, "10th_percentile": 211.12, "90th_percentile": 237.6, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 237.6, "10th_percentile": 224.16, "90th_percentile": 259.19, "count": "12" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 237.6, "10th_percentile": 237.6, "90th_percentile": 238.17, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 238.17, "10th_percentile": 237.6, "90th_percentile": 238.17, "count": "1 through 10" } ] } ] }, { "description": "Prochlorperazine Maleate Tab 10 MG (Base Equivalent)", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "50268068511", "type": "NDC" }, { "code": "Q0164", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.64, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.64 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.32 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.64 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.64 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.1 } ] } ] }, { "description": "HC RENAL FUNCTION PANEL", "code_information": [ { "code": "80069", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 217.19, "discounted_cash": 62.0, "minimum": 8.68, "maximum": 196.9913, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 117.42, "10th_percentile": 117.42, "90th_percentile": 117.42, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 62.55, "10th_percentile": 59.04, "90th_percentile": 62.55, "count": "30" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 71.68 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 87.83 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 60.26, "10th_percentile": 56.88, "90th_percentile": 60.26, "count": "24" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 70.27 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 87.83 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 87.83 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 104.47, "10th_percentile": 104.47, "90th_percentile": 104.47, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 131.38, "10th_percentile": 131.38, "90th_percentile": 131.38, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 80.47 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 34.64, "10th_percentile": 27.28, "90th_percentile": 173.75, "count": "21" }, { "payer_name": "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 164.0, "10th_percentile": 164.0, "90th_percentile": 173.75, "count": "24" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 55.6, "10th_percentile": 8.68, "90th_percentile": 55.76, "count": "83" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 55.6, "10th_percentile": 52.48, "90th_percentile": 60.68, "count": "41" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 55.6, "10th_percentile": 52.48, "90th_percentile": 55.76, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 55.6, "10th_percentile": 55.6, "90th_percentile": 55.76, "count": "29" } ] } ] }, { "description": "HC SERUM SCREENING % REACTIVE ANTIBODY STANDRD METH", "code_information": [ { "code": "86807", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 578.75, "discounted_cash": 167.0, "minimum": 78.65, "maximum": 578.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 326.58 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 400.17 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 320.14 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 400.17 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 400.17 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 578.75 }, { "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" } ] } ] }, { "description": "ALLOGENEIC BONE MARROW TRANSPLANT", "code_information": [ { "code": "014", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 57612.0, "minimum": 57612.72, "maximum": 141678.78, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 141678.78 } ] } ] }, { "description": "HC (SUP SHELL A4419) OST PCH FOR BAR W FLANGE/FLT", "code_information": [ { "code": "A4419", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2.46, "maximum": 2.46, "payers_information": [ { "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" } ] } ] }, { "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": 110.0, "minimum": 70.2, "maximum": 346.0749, "payers_information": [ { "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" } ] } ] }, { "description": "HC SKIN FUNGI CULTURE", "code_information": [ { "code": "87101", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 210.94, "discounted_cash": 61.0, "minimum": 7.71, "maximum": 191.3226, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 63.65 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 78.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 62.4 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 78.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 78.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 71.48 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7.71, "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": 10087.0, "minimum": 10087.83, "maximum": 19759.51, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19759.51 } ] } ] }, { "description": "BRONCHITIS AND ASTHMA WITH CCMCC", "code_information": [ { "code": "202", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6501.0, "minimum": 5862.791, "maximum": 11449.46, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11449.46 } ] } ] }, { "description": "HC (SUP SHELL A4629) TRACHEOSTOMY CARE KIT - A4629 - RU272069", "code_information": [ { "code": "A4629", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 6.63, "maximum": 6.63, "payers_information": [ { "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" } ] } ] }, { "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": 17.0, "minimum": 11.94, "maximum": 55.5538, "payers_information": [ { "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" } ] } ] }, { "description": "HC ARC RBC ANTIBODY IDENTIFICATION", "code_information": [ { "code": "86870", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 455.31, "discounted_cash": 132.0, "minimum": 132.0399, "maximum": 455.31, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 455.31 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 436.0, "10th_percentile": 436.0, "90th_percentile": 474.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 151.76, "10th_percentile": 151.76, "90th_percentile": 151.76, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 151.76, "10th_percentile": 151.76, "90th_percentile": 151.76, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL A6243) HYDROGEL DRG >16<=48 W/O BDR", "code_information": [ { "code": "A6243", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 17.56, "maximum": 17.56, "payers_information": [ { "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" } ] } ] }, { "description": "HC ASSAY OF G6PD ENZYME", "code_information": [ { "code": "82955", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 80.63, "discounted_cash": 23.0, "minimum": 9.7, "maximum": 80.63, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 73.66 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 80.63 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 72.21 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 80.63 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 80.63 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 80.63 }, { "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" } ] } ] }, { "description": "KCl 20 MEQ/L (0.15%) in NaCl 0.45% Inj", "drug_information": { "unit": 1000.0, "type": "ML" }, "code_information": [ { "code": "00990925739", "type": "NDC" }, { "code": "J3480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.76, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 62.35, "10th_percentile": 62.35, "90th_percentile": 62.35, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.76 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC", "code_information": [ { "code": "486", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11432.0, "minimum": 11432.87, "maximum": 24651.94, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24651.94 } ] } ] }, { "description": "HC REPTILASE TEST", "code_information": [ { "code": "85635", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 151.25, "discounted_cash": 43.0, "minimum": 9.85, "maximum": 137.1838, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 81.29 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 99.61 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 79.69 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 99.61 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 99.61 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 91.31 }, { "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" } ] } ] }, { "description": "Pegfilgrastim-jmdb Soln Prefilled Syringe 6 MG/0.6ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "83257000541", "type": "NDC" }, { "code": "Q5108", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 355.635, "maximum": 530.33, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 530.33 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 424.26 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 530.33 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 530.33 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 355.64 } ] } ] }, { "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": "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" } ] } ] }, { "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", "minimum": 20.0025, "maximum": 29.83, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 29.83 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 23.86 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 29.83 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 29.83 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.0 } ] } ] }, { "description": "HC (SUP SHELL Q4186) EPIFIX PER SQ CM", "code_information": [ { "code": "Q4186", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 498.7395, "maximum": 743.8, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 743.8 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 595.04 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 743.8 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 743.8 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 498.74 } ] } ] }, { "description": "Lidocaine HCl Local Inj 2%", "drug_information": { "unit": 20.0, "type": "ML" }, "code_information": [ { "code": "55150025520", "type": "NDC" }, { "code": "J2003", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 12.77, "10th_percentile": 12.77, "90th_percentile": 13.54, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "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": 623.0, "minimum": 623.6827, "maximum": 1950.6214, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 963.52 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 770.82 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 963.52 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 963.52 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 868.47 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1623.0, "10th_percentile": 1623.0, "90th_percentile": 1623.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 550.56, "10th_percentile": 550.56, "90th_percentile": 550.56, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL Q4113) GRAFTJACKET XPRESS, INJECTABLE, 1 CC", "code_information": [ { "code": "Q4113", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2867.06, "maximum": 14294.55, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14294.55 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3583.86 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2867.06 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 3583.86 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 3583.86 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2896.58 } ] } ] }, { "description": "HC (SUP SHELL A4338) INDWELLING CATHETER LATEX", "code_information": [ { "code": "A4338", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 17.48, "maximum": 17.48, "payers_information": [ { "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" } ] } ] }, { "description": "Enoxaparin Sodium Inj Soln Pref Syr 120 MG/0.8ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00955101201", "type": "NDC" }, { "code": "J1650", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.638, "maximum": 12.8, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.8 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2.44 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.95 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2.44 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2.44 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.64 } ] } ] }, { "description": "HC (SUP SHELL L1930) AFO PLASTIC/OTH MATERIAL PREFAB", "code_information": [ { "code": "L1930", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 313.72, "maximum": 313.72, "payers_information": [ { "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" } ] } ] }, { "description": "HC TEAM CONF W/O PAT BY HC PRO", "code_information": [ { "code": "99368", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 166.25, "discounted_cash": 48.0, "minimum": 48.2125, "maximum": 150.7887, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITHOUT CCMCC", "code_information": [ { "code": "735", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3810.0, "minimum": 3810.96, "maximum": 15862.07, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15862.07 } ] } ] }, { "description": "HC (SUP SHELL A5054) CLSD OSTOMY POUCH W/FLANGE", "code_information": [ { "code": "A5054", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2.56, "maximum": 6.39, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.39 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.11 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 6.39 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 6.39 }, { "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" } ] } ] }, { "description": "DIABETES WITHOUT CCMCC", "code_information": [ { "code": "639", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4707.0, "minimum": 4707.65, "maximum": 11637.7619, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "other", "standard_charge_dollar": 4707.65, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 4920.0, "10th_percentile": 4920.0, "90th_percentile": 4920.0, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7323.31 } ] } ] }, { "description": "Alpha1-Proteinase Inhibitor (Human) Inj 1000 MG/20ML", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "13533070501", "type": "NDC" }, { "code": "J0256", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 16.254, "maximum": 66.29, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 66.29 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.24 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 19.39 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 24.24 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 24.24 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.25 } ] } ] }, { "description": "INFLAMMATORY BOWEL DISEASE WITHOUT CCMCC", "code_information": [ { "code": "387", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5604.0, "minimum": 5604.35, "maximum": 8031.83, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8031.83 } ] } ] }, { "description": "MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC", "code_information": [ { "code": "640", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8070.0, "minimum": 8070.26, "maximum": 15745.36, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 8070.26, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 10279.35, "10th_percentile": 10279.35, "90th_percentile": 20291.7, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15745.36 } ] } ] }, { "description": "HC MRI JOINT UPPER EXTREM W/CONTRAST", "code_information": [ { "code": "73222", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2768.44, "discounted_cash": 802.0, "minimum": 802.8476, "maximum": 2510.9751, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2118.32 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1694.64 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2118.32 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2118.32 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2080.99 } ] } ] }, { "description": "TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC", "code_information": [ { "code": "069", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4483.0, "minimum": 4483.48, "maximum": 15007.833, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9417.04 } ] } ] }, { "description": "HC MRI, LUMBAR SPINE", "code_information": [ { "code": "72148", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2668.44, "discounted_cash": 773.0, "minimum": 773.8476, "maximum": 2420.2751, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 683.12, "10th_percentile": 683.12, "90th_percentile": 725.82, "count": "17" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 683.12, "10th_percentile": 683.12, "90th_percentile": 683.12, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 1528.48, "10th_percentile": 1528.48, "90th_percentile": 1528.48, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 768.51, "10th_percentile": 768.51, "90th_percentile": 768.51, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1725.03 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 740.34, "10th_percentile": 740.34, "90th_percentile": 740.34, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1380.01 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1725.03 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1725.03 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1074.3 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 683.12, "10th_percentile": 683.12, "90th_percentile": 725.82, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 462.52, "10th_percentile": 462.52, "90th_percentile": 462.52, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 2134.75, "10th_percentile": 2134.75, "90th_percentile": 2134.75, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 683.12, "10th_percentile": 683.12, "90th_percentile": 683.12, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 683.12, "10th_percentile": 683.12, "90th_percentile": 789.86, "count": "1 through 10" } ] } ] }, { "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": 3.78, "maximum": 36.73, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 36.73 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.64 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.51 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 5.64 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 5.64 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.78 } ] } ] }, { "description": "HC US, HEAD/NECK TISSUES,REAL TIME", "code_information": [ { "code": "76536", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1069.38, "discounted_cash": 310.0, "minimum": 310.1202, "maximum": 969.9277, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 577.81, "10th_percentile": 577.81, "90th_percentile": 577.81, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 307.98, "10th_percentile": 290.52, "90th_percentile": 307.98, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 405.78 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 296.69, "10th_percentile": 279.87, "90th_percentile": 296.69, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 324.62 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 405.78 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 405.78 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 514.06, "10th_percentile": 514.06, "90th_percentile": 514.06, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 672.42, "10th_percentile": 672.42, "90th_percentile": 672.42, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 710.58 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 273.76, "10th_percentile": 11.23, "90th_percentile": 807.0, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 174.85, "10th_percentile": 174.85, "90th_percentile": 174.85, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 855.5, "10th_percentile": 807.0, "90th_percentile": 855.5, "count": "27" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 273.76, "10th_percentile": 258.24, "90th_percentile": 274.38, "count": "20" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 739.21, "10th_percentile": 645.04, "90th_percentile": 775.94, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 273.76, "10th_percentile": 266.31, "90th_percentile": 273.76, "count": "15" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 273.76, "10th_percentile": 273.76, "90th_percentile": 274.38, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 273.76, "10th_percentile": 273.76, "90th_percentile": 273.76, "count": "1 through 10" } ] } ] }, { "description": "CHOLECYSTECTOMY WITH C.D.E. WITH MCC", "code_information": [ { "code": "411", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13226.0, "minimum": 13226.27, "maximum": 38942.54, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 38942.54 } ] } ] }, { "description": "HC (SUP SHELL A6234) HYDROCOLLD DRG <=16 W/O BDR - A6234 - RU272050", "code_information": [ { "code": "A6234", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 9.33, "maximum": 19.45, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.45 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 15.56 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 19.45 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 19.45 }, { "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" } ] } ] }, { "description": "MAJOR THUMB OR JOINT PROCEDURES", "code_information": [ { "code": "506", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8294.0, "minimum": 8294.44, "maximum": 15905.69, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15905.69 } ] } ] }, { "description": "HC ELECTRICAL STIMULATION EA 15 MIN", "code_information": [ { "code": "97032", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 113.44, "discounted_cash": 32.0, "minimum": 14.09, "maximum": 102.8901, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "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" } ] } ] }, { "description": "HC PERQ XHEPATIC PORTOGRAM", "code_information": [ { "code": "75887", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3955.63, "discounted_cash": 1147.0, "minimum": 617.5646, "maximum": 3587.7564, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 854.89 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1047.54 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 838.02 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1047.54 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1047.54 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 617.56 } ] } ] }, { "description": "HC (SUP SHELL A5071) URINARY POUCH W/BARRIER", "code_information": [ { "code": "A5071", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 8.57, "maximum": 18.51, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.51 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.81 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 18.51 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 18.51 }, { "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" } ] } ] }, { "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": 155.0, "minimum": 42.9, "maximum": 486.6599, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 53.63 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 113.5, "10th_percentile": 113.5, "90th_percentile": 113.5, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 42.9 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 53.63 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 53.63 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 221.04, "10th_percentile": 208.46, "90th_percentile": 442.08, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 262.24 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 327.25, "10th_percentile": 327.25, "90th_percentile": 347.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 111.04, "10th_percentile": 104.72, "90th_percentile": 111.04, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 314.73, "10th_percentile": 299.76, "90th_percentile": 314.73, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 111.04, "10th_percentile": 111.04, "90th_percentile": 111.04, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 111.04, "10th_percentile": 111.04, "90th_percentile": 111.04, "count": "1 through 10" } ] } ] }, { "description": "HC THYROID MET IMAGING ADDN LTD", "code_information": [ { "code": "78016", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1523.44, "discounted_cash": 441.0, "minimum": 441.7976, "maximum": 1523.44, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1064.94 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1304.92 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1043.93 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1304.92 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1304.92 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1523.44 } ] } ] }, { "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": 261.0, "minimum": 95.0, "maximum": 819.4201, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "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" } ] } ] }, { "description": "HC MICROSCOPIC EXAM OF URINE", "code_information": [ { "code": "81015", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 44.06, "discounted_cash": 12.0, "minimum": 3.05, "maximum": 39.9624, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 25.04 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 30.69 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 24.55 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 30.69 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 30.69 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.28 }, { "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 Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 3.05, "10th_percentile": 3.05, "90th_percentile": 3.05, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL L0637) LSO SC R ANT/POS PNL PRE CST", "code_information": [ { "code": "L0637", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1404.53, "maximum": 1404.53, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1404.53, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "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": 9.0, "minimum": 9.8774, "maximum": 34.06, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 34.06 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 34.06 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 34.06 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 34.06 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 34.06 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.06 } ] } ] }, { "description": "HC (SUP SHELL A6207) CONTACT LAYER >16<= 48 SQ IN", "code_information": [ { "code": "A6207", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 10.47, "maximum": 10.47, "payers_information": [ { "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" } ] } ] }, { "description": "HC (SUP SHELL L3935) FO NONTORSION JOINT CF", "code_information": [ { "code": "L3935", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 241.15, "maximum": 241.15, "payers_information": [ { "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" } ] } ] }, { "description": "HC (SUP SHELL A4334) URINARY CATH LEG STRAP - A4334 - 27090019", "code_information": [ { "code": "A4334", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 7.01, "maximum": 7.01, "payers_information": [ { "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" } ] } ] }, { "description": "HC (SUP SHELL A4557) LEAD WIRES, PAIR", "code_information": [ { "code": "A4557", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 13.11, "maximum": 13.11, "payers_information": [ { "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" } ] } ] }, { "description": "HC ASSAY OF PORPHOBILINOGEN URINE QUAN", "code_information": [ { "code": "84110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 402.81, "discounted_cash": 116.0, "minimum": 8.44, "maximum": 365.3487, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 57.61 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 70.59 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 56.47 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 70.59 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 70.59 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 78.24 }, { "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" } ] } ] }, { "description": "HC DOPPLER MID CEREBRAL ART", "code_information": [ { "code": "76821", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 516.56, "discounted_cash": 149.0, "minimum": 149.8024, "maximum": 473.7416, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 253.82 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 311.01 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 248.81 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 311.01 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 311.01 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 473.74 } ] } ] }, { "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": 257.0, "minimum": 257.8274, "maximum": 889.06, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 889.06 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 889.06 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 889.06 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 889.06 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 889.06 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 889.06 }, { "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" } ] } ] }, { "description": "HC (SUP SHELL Q4108) INTEGRA MATRIX, PER SQUARE CENTIMETER", "code_information": [ { "code": "Q4108", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 159.012, "maximum": 592.32, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 592.32 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 237.14 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 189.71 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 237.14 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 237.14 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 159.01 } ] } ] }, { "description": "HC CHEST X-RAY W APICAL LORD", "code_information": [ { "code": "71047", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 319.06, "discounted_cash": 92.0, "minimum": 92.5274, "maximum": 289.3874, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 101.93 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 124.9 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 99.92 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 124.9 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 124.9 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 248.17 } ] } ] }, { "description": "HC TRANSFERASE ALANINE AMINO (ALT) (SGPT)", "code_information": [ { "code": "84460", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 90.0, "discounted_cash": 26.0, "minimum": 5.3, "maximum": 81.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 61.76, "10th_percentile": 61.76, "90th_percentile": 66.84, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 31.05, "10th_percentile": 31.05, "90th_percentile": 31.05, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 43.7 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 53.55 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 29.92, "10th_percentile": 29.92, "90th_percentile": 29.92, "count": "13" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 42.84 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 53.55 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 53.55 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 54.94, "10th_percentile": 54.94, "90th_percentile": 54.94, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 67.79, "10th_percentile": 67.79, "90th_percentile": 128.18, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 49.13 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 86.25, "10th_percentile": 16.26, "90th_percentile": 86.25, "count": "12" }, { "payer_name": "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 86.25, "10th_percentile": 60.0, "90th_percentile": 160.0, "count": "14" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 27.6, "10th_percentile": 27.6, "90th_percentile": 29.33, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 27.6, "10th_percentile": 27.6, "90th_percentile": 31.91, "count": "29" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 27.6, "10th_percentile": 27.6, "90th_percentile": 29.33, "count": "1 through 10" } ] } ] }, { "description": "HC URETERAL REFLUX STUDY", "code_information": [ { "code": "78740", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1004.38, "discounted_cash": 291.0, "minimum": 291.2702, "maximum": 1004.38, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 691.48 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 847.3 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 677.83 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 847.3 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 847.3 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1004.38 } ] } ] }, { "description": "HC NATRIURETIC PEPTIDE", "code_information": [ { "code": "83880", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 668.13, "discounted_cash": 193.0, "minimum": 39.26, "maximum": 605.9939, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 382.7, "10th_percentile": 382.7, "90th_percentile": 382.7, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 192.42, "10th_percentile": 192.42, "90th_percentile": 192.42, "count": "14" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 280.17 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 343.3 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 185.36, "10th_percentile": 185.36, "90th_percentile": 185.36, "count": "23" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 274.64 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 343.3 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 343.3 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 340.48, "10th_percentile": 340.48, "90th_percentile": 438.29, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 420.12, "10th_percentile": 420.12, "90th_percentile": 428.19, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 363.96 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 256.56, "10th_percentile": 186.42, "90th_percentile": 534.5, "count": "22" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 39.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 534.5, "10th_percentile": 534.5, "90th_percentile": 534.5, "count": "77" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 171.04, "10th_percentile": 171.04, "90th_percentile": 171.04, "count": "47" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 484.79, "10th_percentile": 484.79, "90th_percentile": 489.6, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 171.04, "10th_percentile": 171.04, "90th_percentile": 171.04, "count": "59" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 171.04, "10th_percentile": 171.04, "90th_percentile": 181.73, "count": "32" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 171.04, "10th_percentile": 171.04, "90th_percentile": 171.04, "count": "25" } ] } ] }, { "description": "MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITHOUT CCMCC", "code_information": [ { "code": "756", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4483.0, "minimum": 4483.48, "maximum": 11323.32, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11323.32 } ] } ] }, { "description": "HC (SUP SHELL A4628) OROPHARYNGEAL SUCTION CATH - A4628 - 27200093", "code_information": [ { "code": "A4628", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 5.33, "maximum": 5.33, "payers_information": [ { "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" } ] } ] }, { "description": "KIDNEY AND URINARY TRACT NEOPLASMS WITHOUT CCMCC", "code_information": [ { "code": "688", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4483.0, "minimum": 4483.48, "maximum": 9316.83, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9316.83 } ] } ] }, { "description": "HC X-RAY CLAVICLE", "code_information": [ { "code": "73000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 417.5, "discounted_cash": 121.0, "minimum": 74.35, "maximum": 378.6725, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 75.84 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 92.93 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 74.35 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 92.93 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 92.93 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 208.63 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 334.0, "10th_percentile": 315.0, "90th_percentile": 334.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 100.8, "10th_percentile": 100.8, "90th_percentile": 100.8, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 302.94, "10th_percentile": 302.94, "90th_percentile": 302.94, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL A4215) STERILE NEEDLE", "code_information": [ { "code": "A4215", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.24, "maximum": 1.55, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.55 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.24 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.55 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.55 } ] } ] }, { "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": 46.6726, "maximum": 160.94, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 113.46 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 139.02 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 111.22 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 139.02 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 139.02 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 101.2, "10th_percentile": 101.2, "90th_percentile": 101.2, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.94 }, { "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" } ] } ] }, { "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": 37.0, "minimum": 18.11, "maximum": 116.7763, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "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" } ] } ] }, { "description": "HC BLOOD CLOT FACTOR VII TEST", "code_information": [ { "code": "85230", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 333.44, "discounted_cash": 96.0, "minimum": 17.9, "maximum": 302.4301, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 147.77 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 181.07 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 144.86 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 181.07 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 181.07 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 165.94 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% 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": 113.0, "minimum": 22.94, "maximum": 355.4352, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 189.44 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 232.12 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 185.7 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 232.12 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 232.12 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 212.67 }, { "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" } ] } ] }, { "description": "HC ULTRASOUND,TRANSVAGINAL", "code_information": [ { "code": "76830", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 718.13, "discounted_cash": 208.0, "minimum": 208.2577, "maximum": 718.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 388.07, "10th_percentile": 388.07, "90th_percentile": 420.05, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 195.12, "10th_percentile": 195.12, "90th_percentile": 195.12, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 420.1 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 199.24, "10th_percentile": 187.97, "90th_percentile": 199.24, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 336.08 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 420.1 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 420.1 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 365.96, "10th_percentile": 365.96, "90th_percentile": 365.96, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 451.56, "10th_percentile": 434.2, "90th_percentile": 451.56, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 718.13 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 574.5, "10th_percentile": 542.0, "90th_percentile": 574.5, "count": "67" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 183.84, "10th_percentile": 183.84, "90th_percentile": 183.84, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 496.47, "10th_percentile": 496.47, "90th_percentile": 496.47, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 183.84, "10th_percentile": 173.44, "90th_percentile": 200.54, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 183.84, "10th_percentile": 183.84, "90th_percentile": 183.84, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 183.84, "10th_percentile": 183.84, "90th_percentile": 183.84, "count": "1 through 10" } ] } ] }, { "description": "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": 7.7175, "maximum": 62.76, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 62.76 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.46 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 9.17 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 11.46 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 11.46 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.72 } ] } ] }, { "description": "Tobramycin Sulfate Inj 80 MG/2ML (40 MG/ML) (Base Equiv)", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "67457047300", "type": "NDC" }, { "code": "J3260", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 5.04, "maximum": 44.09, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 44.09 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.47 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.98 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 7.47 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 7.47 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.04 } ] } ] }, { "description": "HC (SUP SHELL A4265) PARAFFIN", "code_information": [ { "code": "A4265", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 4.86, "maximum": 4.86, "payers_information": [ { "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" } ] } ] }, { "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": 1.0, "payers_information": [ { "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" } ] } ] }, { "description": "HC HEP A ANTIBODY TOTAL", "code_information": [ { "code": "86708", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 185.63, "discounted_cash": 53.0, "minimum": 12.39, "maximum": 168.3664, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 100.24, "10th_percentile": 100.24, "90th_percentile": 100.24, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 95.93 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 117.55 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 48.55, "10th_percentile": 48.55, "90th_percentile": 48.55, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 94.04 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 117.55 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 117.55 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 94.59, "10th_percentile": 94.59, "90th_percentile": 94.59, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 112.15, "10th_percentile": 112.15, "90th_percentile": 116.72, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 114.86 }, { "payer_name": "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 140.0, "10th_percentile": 140.0, "90th_percentile": 148.5, "count": "17" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 47.52, "10th_percentile": 47.52, "90th_percentile": 47.52, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 44.8, "10th_percentile": 44.8, "90th_percentile": 47.52, "count": "1 through 10" } ] } ] }, { "description": "Penicillin G Benzathin Intramuscular Susp 2400000 un", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "60793070110", "type": "NDC" }, { "code": "J0561", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 84.987, "maximum": 204.88, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 204.88 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 126.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 101.4 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 126.75 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 126.75 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 84.99 } ] } ] }, { "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": 51.2024, "maximum": 176.56, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 176.56 } ] } ] }, { "description": "HC ASSAY OF SERUM POTASSIUM", "code_information": [ { "code": "84132", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 37.19, "discounted_cash": 10.0, "minimum": 4.76, "maximum": 37.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 10.71, "10th_percentile": 10.71, "90th_percentile": 10.71, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 37.19 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 37.19 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 10.32, "10th_percentile": 10.32, "90th_percentile": 10.32, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 37.13 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 37.19 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 37.19 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 18.95, "10th_percentile": 18.95, "90th_percentile": 18.95, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.19 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 29.75, "10th_percentile": 29.75, "90th_percentile": 29.75, "count": "1 through 10" }, { "payer_name": "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 29.75, "10th_percentile": 29.75, "90th_percentile": 29.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 8.63, "10th_percentile": 8.63, "90th_percentile": 8.63, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 9.52, "10th_percentile": 9.52, "90th_percentile": 11.66, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 9.52, "10th_percentile": 9.52, "90th_percentile": 9.52, "count": "1 through 10" } ] } ] }, { "description": "HC NEUTRALIZATION TEST VIRAL", "code_information": [ { "code": "86382", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 339.69, "discounted_cash": 98.0, "minimum": 16.91, "maximum": 308.0988, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 139.58 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 171.03 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 136.82 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 171.03 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 171.03 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 156.76 }, { "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" } ] } ] }, { "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": 1.5435, "maximum": 7.51, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 124.7, "10th_percentile": 124.7, "90th_percentile": 124.7, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7.51 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2.3 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.84 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2.3 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2.3 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.54 } ] } ] }, { "description": "HC ASSAY BLOOD CARBON MONOXIDE", "code_information": [ { "code": "82375", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 220.63, "discounted_cash": 63.0, "minimum": 12.32, "maximum": 200.1114, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 101.76 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 124.69 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 99.75 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 124.69 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 124.69 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 114.21 }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 176.5, "10th_percentile": 176.5, "90th_percentile": 176.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 65.31, "10th_percentile": 65.31, "90th_percentile": 65.31, "count": "1 through 10" } ] } ] }, { "description": "HC ASSAY OF URINE CHLORIDE", "code_information": [ { "code": "82436", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 88.75, "discounted_cash": 25.0, "minimum": 5.75, "maximum": 80.4963, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 41.49 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 50.84 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 40.68 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 50.84 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 50.84 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 53.31 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC IADNA HIV-1 QUANT & REVERSE TRANSCRIPTION", "code_information": [ { "code": "87536", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 790.0, "discounted_cash": 229.0, "minimum": 85.1, "maximum": 788.9195, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 463.84 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 568.36 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 454.69 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 568.36 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 568.36 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 788.92 }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 632.0, "10th_percentile": 596.25, "90th_percentile": 632.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 202.24, "10th_percentile": 202.24, "90th_percentile": 202.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 190.8, "10th_percentile": 190.8, "90th_percentile": 202.24, "count": "1 through 10" } ] } ] }, { "description": "VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC", "code_information": [ { "code": "805", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6725.0, "minimum": 6725.22, "maximum": 12722.67, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12722.67 } ] } ] }, { "description": "CESAREAN SECTION WITHOUT STERILIZATION WITH MCC", "code_information": [ { "code": "786", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9863.0, "minimum": 9863.66, "maximum": 19445.92, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19445.92 } ] } ] }, { "description": "OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH MCC", "code_information": [ { "code": "673", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22865.0, "minimum": 22865.75, "maximum": 49532.58, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 49532.58 } ] } ] }, { "description": "HC MRI CHEST WO/W CONTRAST", "code_information": [ { "code": "71552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3750.94, "discounted_cash": 1087.0, "minimum": 900.0, "maximum": 3402.1026, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2668.87 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2135.09 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2668.87 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2668.87 }, { "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": 3208.9 } ] } ] }, { "description": "HC X-RAY ELBOW 2 VW", "code_information": [ { "code": "73070", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 393.44, "discounted_cash": 114.0, "minimum": 74.35, "maximum": 356.8501, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 75.84 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 92.93 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 74.35 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 92.93 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 92.93 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 180.5 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 297.0, "10th_percentile": 297.0, "90th_percentile": 629.5, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL L8603) COLLAGEN IMP URINARY 2.5 ML", "code_information": [ { "code": "L8603", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 536.09, "maximum": 536.09, "payers_information": [ { "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" } ] } ] }, { "description": "MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CCMCC", "code_information": [ { "code": "373", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6052.0, "minimum": 4559.7009, "maximum": 8575.3, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8575.3 } ] } ] }, { "description": "TRANSURETHRAL PROSTATECTOMY WITH CCMCC", "code_information": [ { "code": "713", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5380.0, "minimum": 5380.18, "maximum": 17723.55, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17723.55 } ] } ] }, { "description": "HC EPSTEIN-BARR ANTIBODY,V CAPSID", "code_information": [ { "code": "86665", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 225.63, "discounted_cash": 65.0, "minimum": 18.14, "maximum": 204.6464, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 243.8, "10th_percentile": 243.8, "90th_percentile": 243.8, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 117.98 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 144.57 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 115.65 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 144.57 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 144.57 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 141.87, "10th_percentile": 141.87, "90th_percentile": 141.87, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 168.17 }, { "payer_name": "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 361.0, "10th_percentile": 180.5, "90th_percentile": 361.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 115.52, "10th_percentile": 115.52, "90th_percentile": 115.52, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL Q4010) CAST SUP SHT ARM ADULT FBRGL", "code_information": [ { "code": "Q4010", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 24.8, "maximum": 24.8, "payers_information": [ { "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" } ] } ] }, { "description": "HC CLOSTRIDIUM TOXIN A W/OPTIC", "code_information": [ { "code": "87803", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 92.5, "discounted_cash": 26.0, "minimum": 16.0, "maximum": 92.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 25.11, "10th_percentile": 25.11, "90th_percentile": 25.11, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 92.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 92.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 24.19, "10th_percentile": 24.19, "90th_percentile": 25.66, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 92.5 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 92.5 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 92.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 92.5 }, { "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 Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 22.32, "10th_percentile": 22.32, "90th_percentile": 22.32, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 23.68, "10th_percentile": 23.68, "90th_percentile": 23.72, "count": "1 through 10" } ] } ] }, { "description": "CONNECTIVE TISSUE DISORDERS WITH MCC", "code_information": [ { "code": "545", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12329.0, "minimum": 12329.57, "maximum": 29256.71, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 29256.71 } ] } ] }, { "description": "HC MICROHEMATOCRIT,SPUN", "code_information": [ { "code": "85013", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 72.81, "discounted_cash": 21.0, "minimum": 7.0, "maximum": 66.0387, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 19.56 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.97 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 19.17 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 23.97 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 23.97 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 64.89 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7.0, "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": 76.0, "minimum": 14.27, "maximum": 239.5024, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 154.42, "10th_percentile": 142.66, "90th_percentile": 162.24, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 76.05, "10th_percentile": 71.73, "90th_percentile": 76.05, "count": "11" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 95.93 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 117.55 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 69.11, "10th_percentile": 69.11, "90th_percentile": 73.27, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 94.04 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 117.55 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 117.55 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 134.57, "10th_percentile": 126.92, "90th_percentile": 134.57, "count": "11" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 159.62, "10th_percentile": 159.62, "90th_percentile": 166.04, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 132.29 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 49.1, "10th_percentile": 49.1, "90th_percentile": 49.1, "count": "1 through 10" }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 211.25, "10th_percentile": 199.25, "90th_percentile": 211.25, "count": "137" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 67.6, "10th_percentile": 63.76, "90th_percentile": 67.6, "count": "19" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 182.51, "10th_percentile": 182.51, "90th_percentile": 191.61, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 67.6, "10th_percentile": 63.76, "90th_percentile": 67.6, "count": "32" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 67.6, "10th_percentile": 67.6, "90th_percentile": 67.6, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 67.6, "10th_percentile": 55.44, "90th_percentile": 67.75, "count": "18" } ] } ] }, { "description": "HC X-RAYS, BONE LENGTH STUDIES", "code_information": [ { "code": "77073", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 919.38, "discounted_cash": 266.0, "minimum": 94.37, "maximum": 833.8777, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 96.27 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 117.96 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 94.37 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 117.96 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 117.96 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 273.51 } ] } ] }, { "description": "HC (SUP SHELL L3809) WHFO W/O JOINTS PRE OTS", "code_information": [ { "code": "L3809", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 272.97, "maximum": 272.97, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 272.97, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "148", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4259.0, "minimum": 4259.31, "maximum": 9397.0, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9397.0 } ] } ] }, { "description": "INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH MCC", "code_information": [ { "code": "757", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10312.0, "minimum": 10312.0, "maximum": 16880.64, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16880.64 } ] } ] }, { "description": "HC NM MYOCARDIAL SPECT SINGLE STUDY AT REST OR STRESS", "code_information": [ { "code": "78451", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4980.31, "discounted_cash": 1444.0, "minimum": 616.37, "maximum": 4517.1412, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 628.78 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 770.47 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 616.37 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 770.47 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 770.47 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2114.87 } ] } ] }, { "description": "OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "718", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4259.0, "minimum": 4259.31, "maximum": 15833.78, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15833.78 } ] } ] }, { "description": "HC ELECTRON MICROSCOPY,DIAGNOSTIC", "code_information": [ { "code": "88348", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1577.5, "discounted_cash": 457.0, "minimum": 457.475, "maximum": 1577.5, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1577.5 } ] } ] }, { "description": "HC ASSAY OF MANGANESE", "code_information": [ { "code": "83785", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 330.31, "discounted_cash": 95.0, "minimum": 26.65, "maximum": 299.5912, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 202.95 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 248.68 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 198.94 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 248.68 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 248.68 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 247.06 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 26.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 264.25, "10th_percentile": 264.25, "90th_percentile": 264.25, "count": "1 through 10" } ] } ] }, { "description": "VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC", "code_information": [ { "code": "806", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5380.0, "minimum": 5380.18, "maximum": 8888.89, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8888.89 } ] } ] }, { "description": "HC EPSTEIN-BARR ANTIBODY,NUCLEAR", "code_information": [ { "code": "86664", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 225.63, "discounted_cash": 65.0, "minimum": 15.29, "maximum": 204.6464, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 121.9, "10th_percentile": 121.9, "90th_percentile": 121.9, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 117.98 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 144.57 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 115.65 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 144.57 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 144.57 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 141.75 }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 180.5, "10th_percentile": 180.5, "90th_percentile": 180.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 57.76, "10th_percentile": 57.76, "90th_percentile": 57.76, "count": "1 through 10" } ] } ] }, { "description": "Chlorpromazine HCl Inj 25 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "55150031801", "type": "NDC" }, { "code": "J3230", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 91.476, "maximum": 431.38, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 431.38 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 136.42 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 109.14 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 136.42 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 136.42 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 91.48 } ] } ] }, { "description": "OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH MCC", "code_information": [ { "code": "867", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12105.0, "minimum": 12105.4, "maximum": 24676.69, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24676.69 } ] } ] }, { "description": "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": 257.0, "minimum": 257.8274, "maximum": 889.06, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 889.06 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 889.06 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 889.06 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 889.06 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 889.06 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 889.06 }, { "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" } ] } ] }, { "description": "HC (SUP SHELL A4357) BEDSIDE DRAINAGE BAG", "code_information": [ { "code": "A4357", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 11.76, "maximum": 17.85, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.85 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 14.28 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 17.85 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 17.85 }, { "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" } ] } ] }, { "description": "INTRAOCULAR PROCEDURES WITH CCMCC", "code_information": [ { "code": "116", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8966.0, "minimum": 8966.96, "maximum": 21315.65, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21315.65 } ] } ] }, { "description": "HC PATH CONSULT IN SURG,W ADDN FRZ SEC", "code_information": [ { "code": "88332", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 143.44, "discounted_cash": 41.0, "minimum": 41.5976, "maximum": 143.44, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 143.44 } ] } ] }, { "description": "HC ED LEVEL 3", "code_information": [ { "code": "99283", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1074.06, "discounted_cash": 311.0, "minimum": 311.4774, "maximum": 1074.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 535.03, "10th_percentile": 535.03, "90th_percentile": 659.9, "count": "32" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 309.33, "10th_percentile": 269.01, "90th_percentile": 309.33, "count": "59" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 1074.06 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 1074.06 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 297.99, "10th_percentile": 259.15, "90th_percentile": 297.99, "count": "81" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1074.06 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.1, "median_amount": 321.54, "10th_percentile": 219.3, "90th_percentile": 608.96, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 598.62, "10th_percentile": 598.62, "90th_percentile": 675.37, "count": "31" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 79.93, "median_amount": 686.8, "10th_percentile": 686.8, "90th_percentile": 686.8, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 345.76, "10th_percentile": 71.22, "90th_percentile": 747.25, "count": "174" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 305.9, "10th_percentile": 305.9, "90th_percentile": 305.9, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 859.25, "10th_percentile": 747.25, "90th_percentile": 859.25, "count": "1629" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 274.96, "10th_percentile": 239.12, "90th_percentile": 274.96, "count": "202" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 684.48, "10th_percentile": 684.48, "90th_percentile": 684.48, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 274.96, "10th_percentile": 239.12, "90th_percentile": 276.48, "count": "223" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 274.96, "10th_percentile": 239.12, "90th_percentile": 274.96, "count": "110" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 274.96, "10th_percentile": 239.12, "90th_percentile": 274.96, "count": "76" } ] } ] }, { "description": "OSTEOMYELITIS WITHOUT CCMCC", "code_information": [ { "code": "541", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6501.0, "minimum": 6501.05, "maximum": 9282.64, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9282.64 } ] } ] }, { "description": "HC GASTROESOPHAGEAL REFLUX EXAM", "code_information": [ { "code": "78262", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1104.38, "discounted_cash": 320.0, "minimum": 320.2702, "maximum": 1104.38, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 809.67 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 992.12 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 793.69 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 992.12 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 992.12 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1104.38 } ] } ] }, { "description": "RENAL FAILURE WITHOUT CCMCC", "code_information": [ { "code": "684", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4931.0, "minimum": 4931.83, "maximum": 10955.025, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7076.92 } ] } ] }, { "description": "HC X-RAY OPTIC FORAMEN", "code_information": [ { "code": "70190", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 868.44, "discounted_cash": 251.0, "minimum": 97.22, "maximum": 787.6751, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 99.18 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 121.53 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 97.22 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 121.53 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 121.53 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 228.37 } ] } ] }, { "description": "HC HISTOPLASMA", "code_information": [ { "code": "86698", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 136.25, "discounted_cash": 39.0, "minimum": 13.79, "maximum": 127.8402, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 103.17 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 126.42 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 101.13 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 126.42 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 126.42 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 127.84 }, { "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" } ] } ] }, { "description": "SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH MCC", "code_information": [ { "code": "576", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19727.0, "minimum": 19727.31, "maximum": 57780.15, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 57780.15 } ] } ] }, { "description": "HC BIOFEEDBACK TRAIN ANY METH", "code_information": [ { "code": "90901", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 150.0, "discounted_cash": 43.0, "minimum": 16.05, "maximum": 136.05, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "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" } ] } ] }, { "description": "Insulin Lispro Inj 100 Unit/ML", "drug_information": { "unit": 3.0, "type": "ML" }, "code_information": [ { "code": "00002822259", "type": "NDC" }, { "code": "J1815", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 13.8, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.8 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.08 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.08 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.08 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC (SUP SHELL C9362) IMPLNT,BON VOID FILLER-STRIP", "code_information": [ { "code": "C9362", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 329.7735, "maximum": 329.7735, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 329.77 } ] } ] }, { "description": "HC IMMUNOASSAY, TUMOR ANTIGEN, CA 125", "code_information": [ { "code": "86304", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 293.13, "discounted_cash": 85.0, "minimum": 20.81, "maximum": 265.8689, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 171.74 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 210.44 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 81.32, "10th_percentile": 81.32, "90th_percentile": 81.32, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 168.35 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 210.44 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 210.44 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 192.92 }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 234.5, "10th_percentile": 234.5, "90th_percentile": 234.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 75.04, "10th_percentile": 75.04, "90th_percentile": 75.04, "count": "1 through 10" } ] } ] }, { "description": "OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC", "code_information": [ { "code": "802", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17485.0, "minimum": 17485.57, "maximum": 46968.48, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 46968.48 } ] } ] }, { "description": "HC CT GUIDANCE STEREOTACTIC LOCALIZATION", "code_information": [ { "code": "77011", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 992.5, "discounted_cash": 287.0, "minimum": 287.825, "maximum": 992.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 992.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 992.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 992.5 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 992.5 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 992.5 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 992.5 } ] } ] }, { "description": "LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC", "code_information": [ { "code": "418", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7173.0, "minimum": 7173.57, "maximum": 19942.24, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19942.24 } ] } ] }, { "description": "HC ASSAY OF BARBITURATES - 80345 - 30100326", "code_information": [ { "code": "80345", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 208.75, "discounted_cash": 60.0, "minimum": 60.5375, "maximum": 189.3363, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 101.05 } ] } ] }, { "description": "POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES", "code_information": [ { "code": "769", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6725.0, "minimum": 6725.22, "maximum": 19921.02, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19921.02 } ] } ] }, { "description": "HC (SUP SHELL L4361) PNEUMA/VAC WALK BOOT PRE OTS", "code_information": [ { "code": "L4361", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 424.24, "maximum": 424.24, "payers_information": [ { "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" } ] } ] }, { "description": "HC THROMBIN TIME, PLASMA", "code_information": [ { "code": "85670", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 89.38, "discounted_cash": 25.0, "minimum": 5.77, "maximum": 81.0677, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 47.71 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 58.46 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 46.77 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 58.46 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 58.46 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 53.49 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Bumetanide Inj 0.25 MG/ML", "drug_information": { "unit": 4.0, "type": "ML" }, "code_information": [ { "code": "00641600801", "type": "NDC" }, { "code": "J1939", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.7955, "maximum": 2.68, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2.68 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2.14 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2.68 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2.68 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.8 } ] } ] }, { "description": "HC (SUP SHELL A4213) 20+ CC SYRINGE ONLY", "code_information": [ { "code": "A4213", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2.25, "maximum": 2.82, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2.82 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2.25 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2.82 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2.82 } ] } ] }, { "description": "AICD GENERATOR PROCEDURES", "code_information": [ { "code": "245", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9191.0, "minimum": 9191.13, "maximum": 53786.04, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 53786.04 } ] } ] }, { "description": "LIVER TRANSPLANT WITH MCC OR INTESTINAL TRANSPLANT", "code_information": [ { "code": "005", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 31384.0, "minimum": 31384.36, "maximum": 121550.28, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 121550.28 } ] } ] }, { "description": "ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC", "code_information": [ { "code": "061", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10536.0, "minimum": 10536.18, "maximum": 32503.4, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 32503.4 } ] } ] }, { "description": "LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC", "code_information": [ { "code": "824", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10984.0, "minimum": 10984.53, "maximum": 26709.11, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26709.11 } ] } ] }, { "description": "HC ASSAY OF METANEPHRINES", "code_information": [ { "code": "83835", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1052.19, "discounted_cash": 305.0, "minimum": 16.94, "maximum": 954.3363, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 182.58, "10th_percentile": 182.58, "90th_percentile": 182.58, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 139.86 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 171.37 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 137.1 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 171.37 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 171.37 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 157.04 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 255.0, "10th_percentile": 255.0, "90th_percentile": 841.75, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 81.6, "10th_percentile": 81.6, "90th_percentile": 311.45, "count": "1 through 10" } ] } ] }, { "description": "CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC", "code_information": [ { "code": "260", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12329.0, "minimum": 12329.57, "maximum": 38347.19, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 38347.19 } ] } ] }, { "description": "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": "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" } ] } ] }, { "description": "HC US, BREAST UNILAT COMPLETE", "code_information": [ { "code": "76641", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 612.19, "discounted_cash": 177.0, "minimum": 177.5351, "maximum": 578.0235, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 359.29 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 287.43 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 359.29 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 359.29 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 578.02 } ] } ] }, { "description": "OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC", "code_information": [ { "code": "922", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9415.0, "minimum": 9415.31, "maximum": 20623.64, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20623.64 } ] } ] }, { "description": "HC RO SET RADN THERAPY FIELD COMPLEX", "code_information": [ { "code": "77290", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2524.38, "discounted_cash": 732.0, "minimum": 732.0702, "maximum": 2289.6127, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1671.84 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2048.58 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1638.86 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2048.58 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2048.58 } ] } ] }, { "description": "HC UNLISTED CT PROCEDURE", "code_information": [ { "code": "76497", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 335.0, "discounted_cash": 97.0, "minimum": 97.15, "maximum": 335.0, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 335.0 } ] } ] }, { "description": "HC MRI CERV SPINE CONTRAST", "code_information": [ { "code": "72142", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2787.5, "discounted_cash": 808.0, "minimum": 808.375, "maximum": 2528.2625, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2118.32 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1694.64 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2118.32 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2118.32 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1686.2 } ] } ] }, { "description": "NEONATE WITH OTHER SIGNIFICANT PROBLEMS", "code_information": [ { "code": "794", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7621.0, "minimum": 7621.92, "maximum": 17399.36, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17399.36 } ] } ] }, { "description": "HC BCR/ABL1 GENE MINOR BP", "code_information": [ { "code": "81207", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1550.31, "discounted_cash": 449.0, "minimum": 144.84, "maximum": 1406.1312, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 362.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 443.88 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 355.11 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 443.88 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 443.88 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1342.74 }, { "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" } ] } ] }, { "description": "Enoxaparin Sodium Inj Soln Pref Syr 80 MG/0.8ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "71288043586", "type": "NDC" }, { "code": "J1650", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.638, "maximum": 12.8, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.8 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2.44 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.95 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2.44 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2.44 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.64 } ] } ] }, { "description": "SPINAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "030", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5828.0, "minimum": 5828.52, "maximum": 25879.17, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25879.17 } ] } ] }, { "description": "HC (SUP SHELL A6233) HYDROGEL DRESSING >48 SQ IN", "code_information": [ { "code": "A6233", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 27.33, "maximum": 27.33, "payers_information": [ { "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" } ] } ] }, { "description": "HC (SUP SHELL L2270) VARUS/VALGUS STRAP PADDED/LI", "code_information": [ { "code": "L2270", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 72.17, "maximum": 72.17, "payers_information": [ { "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" } ] } ] }, { "description": "HC XRAY FEMUR =>2 VW", "code_information": [ { "code": "73552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 431.25, "discounted_cash": 125.0, "minimum": 125.0625, "maximum": 391.1438, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 252.26, "10th_percentile": 252.26, "90th_percentile": 252.26, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 124.2, "10th_percentile": 117.18, "90th_percentile": 124.2, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 119.65, "10th_percentile": 119.65, "90th_percentile": 119.65, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 228.37 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 345.0, "10th_percentile": 345.0, "90th_percentile": 345.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 325.5, "10th_percentile": 325.5, "90th_percentile": 345.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 110.4, "10th_percentile": 104.16, "90th_percentile": 110.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 110.4, "10th_percentile": 110.4, "90th_percentile": 110.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 110.4, "10th_percentile": 110.4, "90th_percentile": 110.4, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 110.4, "10th_percentile": 110.4, "90th_percentile": 110.4, "count": "1 through 10" } ] } ] }, { "description": "Denosumab Inj Soln Prefilled Syringe 60 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "55513071021", "type": "NDC" }, { "code": "J0897", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 87.6015, "maximum": 270.17, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 270.17 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 130.65 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 104.52 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 130.65 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 130.65 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 87.6 } ] } ] }, { "description": "HC (SUP SHELL L8610) OCULAR IMPLANT", "code_information": [ { "code": "L8610", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 716.57, "maximum": 716.57, "payers_information": [ { "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" } ] } ] }, { "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": 152.0, "minimum": 94.07, "maximum": 477.0276, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 151.47, "10th_percentile": 151.47, "90th_percentile": 151.47, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "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 Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 134.64, "10th_percentile": 134.64, "90th_percentile": 134.64, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 134.64, "10th_percentile": 134.64, "90th_percentile": 134.64, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 134.64, "10th_percentile": 134.64, "90th_percentile": 134.64, "count": "1 through 10" } ] } ] }, { "description": "HC AG DETECT NOS, EIA, MULT STEP", "code_information": [ { "code": "87449", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 369.06, "discounted_cash": 107.0, "minimum": 11.98, "maximum": 334.7374, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 94.58 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 115.89 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 92.71 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 115.89 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 115.89 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 111.06 }, { "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" } ] } ] }, { "description": "DISORDERS OF THE BILIARY TRACT WITH MCC", "code_information": [ { "code": "444", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9639.0, "minimum": 9639.48, "maximum": 19698.21, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19698.21 } ] } ] }, { "description": "HC ASSAY OF CALCIUM, IONIZED", "code_information": [ { "code": "82330", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 235.94, "discounted_cash": 68.0, "minimum": 13.68, "maximum": 213.9976, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 67.95, "10th_percentile": 67.95, "90th_percentile": 67.95, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 112.78 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 138.19 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 110.55 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 138.19 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 138.19 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 126.82 }, { "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 Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 60.4, "10th_percentile": 60.4, "90th_percentile": 64.18, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 60.4, "10th_percentile": 60.4, "90th_percentile": 60.4, "count": "1 through 10" } ] } ] }, { "description": "Ampicillin & Sulbactam Sodium For Inj 3 (2-1) GM", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "44567021110", "type": "NDC" }, { "code": "J0295", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 4.9455, "maximum": 35.12, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 35.12 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.38 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.9 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 7.38 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 7.38 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.95 } ] } ] }, { "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", "minimum": 5.13, "maximum": 5.13, "payers_information": [ { "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" } ] } ] }, { "description": "HC (SUP SHELL L8501) TRACHEOSTOMY SPEAKING VALVE", "code_information": [ { "code": "L8501", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 197.18, "maximum": 197.18, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 197.18, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC CLOT INHIB PROTEIN S,TOTAL", "code_information": [ { "code": "85305", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 69.38, "discounted_cash": 20.0, "minimum": 11.61, "maximum": 69.38, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 69.38 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 69.38 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 69.38 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 69.38 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 69.38 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 69.38 }, { "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" } ] } ] }, { "description": "HC MRI, CHEST", "code_information": [ { "code": "71550", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2893.44, "discounted_cash": 839.0, "minimum": 839.0976, "maximum": 2624.3501, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1725.03 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1380.01 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1725.03 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1725.03 }, { "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": 2362.97 } ] } ] }, { "description": "HC US, OB >/= 14 WKS, ADD'L FETUS", "code_information": [ { "code": "76810", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1101.88, "discounted_cash": 319.0, "minimum": 210.23, "maximum": 999.4052, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 262.79 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 210.23 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 262.79 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 262.79 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 349.66 } ] } ] }, { "description": "HC (SUP SHELL A4351) STRAIGHT TIP URINE CATHETER", "code_information": [ { "code": "A4351", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2.58, "maximum": 2.58, "payers_information": [ { "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" } ] } ] }, { "description": "HC WORK HARDENING EA ADD HR", "code_information": [ { "code": "97546", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 306.25, "discounted_cash": 88.0, "minimum": 88.8125, "maximum": 277.7688, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "HC X-RAY FACIAL BONES <3 VW", "code_information": [ { "code": "70140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 385.0, "discounted_cash": 111.0, "minimum": 80.1, "maximum": 349.195, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 81.71 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 100.12 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 80.1 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 100.12 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 100.12 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 191.76 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 290.5, "10th_percentile": 290.5, "90th_percentile": 290.5, "count": "1 through 10" } ] } ] }, { "description": "HC ASSAY OF BLOOD PKU", "code_information": [ { "code": "84030", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 391.25, "discounted_cash": 113.0, "minimum": 5.5, "maximum": 354.8637, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 45.45 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 55.69 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 44.55 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 55.69 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 55.69 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50.99 }, { "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" } ] } ] }, { "description": "HC CHLAMYDIA, ANTIBODY", "code_information": [ { "code": "86631", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 98.44, "discounted_cash": 28.0, "minimum": 11.82, "maximum": 98.44, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 97.63 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 98.44 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 95.7 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 98.44 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 98.44 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 98.44 }, { "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" } ] } ] }, { "description": "HC (SUP SHELL C9356) TENOGLIDE TENDON PROT, CM2", "code_information": [ { "code": "C9356", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 352.9575, "maximum": 352.9575, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 352.96 } ] } ] }, { "description": "KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC", "code_information": [ { "code": "485", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18158.0, "minimum": 18158.09, "maximum": 38044.22, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 38044.22 } ] } ] }, { "description": "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": 599.0, "minimum": 599.7577, "maximum": 2068.13, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2068.13 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2068.13 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2068.13 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2068.13 }, { "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 } ] } ] }, { "description": "HC BLOOD METHEMOGLOBIN, QUANT", "code_information": [ { "code": "83050", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 142.19, "discounted_cash": 41.0, "minimum": 8.2, "maximum": 128.9663, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 74.05 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 59.24 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 74.05 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 74.05 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 76.02 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.2, "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": 373.0, "minimum": 373.1024, "maximum": 1286.56, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 891.33 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1092.19 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 873.75 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1092.19 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1092.19 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1286.56 } ] } ] }, { "description": "HC RETICULOCYTE COUNT, AUTO", "code_information": [ { "code": "85045", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 128.44, "discounted_cash": 37.0, "minimum": 3.99, "maximum": 116.4951, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 33.07 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 40.52 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 33.64, "10th_percentile": 33.64, "90th_percentile": 35.64, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 32.42 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 40.52 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 40.52 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.99 }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 97.0, "10th_percentile": 97.0, "90th_percentile": 102.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 32.88, "10th_percentile": 31.04, "90th_percentile": 32.98, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 93.19, "10th_percentile": 93.19, "90th_percentile": 93.19, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 32.88, "10th_percentile": 31.04, "90th_percentile": 32.88, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 32.88, "10th_percentile": 32.88, "90th_percentile": 32.98, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 32.98, "10th_percentile": 31.04, "90th_percentile": 32.98, "count": "1 through 10" } ] } ] }, { "description": "HC ASSAY OF ADP & AMP", "code_information": [ { "code": "82030", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 399.69, "discounted_cash": 115.0, "minimum": 25.8, "maximum": 362.5188, "payers_information": [ { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 260.94 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 260.94 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 239.18 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 212.95 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 260.94 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 208.75 } ] } ] }, { "description": "OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT MCC", "code_information": [ { "code": "320", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4707.0, "minimum": 4707.65, "maximum": 28356.03, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28356.03 } ] } ] }, { "description": "Esmolol HCl-Sodium Chloride IV Soln 2500 MG/250ML", "drug_information": { "unit": 250.0, "type": "ML" }, "code_information": [ { "code": "67457065725", "type": "NDC" }, { "code": "J1805", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.32, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.32 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.05 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.32 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.32 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "MAJOR ESOPHAGEAL DISORDERS WITH CC", "code_information": [ { "code": "369", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6501.0, "minimum": 6501.05, "maximum": 11791.34, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11791.34 } ] } ] }, { "description": "Perphenazine Tab 4 MG", "drug_information": { "unit": 100.0, "type": "EA" }, "code_information": [ { "code": "00603506121", "type": "NDC" }, { "code": "Q0175", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.512, "maximum": 29.83, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 29.83 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.8 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2.25 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.51 } ] } ] }, { "description": "PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC", "code_information": [ { "code": "243", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6276.0, "minimum": 6276.87, "maximum": 25121.14, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25121.14 } ] } ] }, { "description": "HC MICROSOMAL ANTIBODY", "code_information": [ { "code": "86376", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 327.19, "discounted_cash": 94.0, "minimum": 14.55, "maximum": 296.7613, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 176.85, "10th_percentile": 176.85, "90th_percentile": 176.85, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 94.23, "10th_percentile": 94.23, "90th_percentile": 94.23, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 120.13 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 147.2 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 90.78, "10th_percentile": 90.78, "90th_percentile": 90.78, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 117.76 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 147.2 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 147.2 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 157.34, "10th_percentile": 157.34, "90th_percentile": 157.34, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 197.87, "10th_percentile": 166.03, "90th_percentile": 205.74, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 134.89 }, { "payer_name": "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 261.75, "10th_percentile": 247.0, "90th_percentile": 261.75, "count": "15" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 83.76, "10th_percentile": 79.04, "90th_percentile": 83.98, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 237.41, "10th_percentile": 237.41, "90th_percentile": 237.41, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 79.04, "10th_percentile": 79.04, "90th_percentile": 79.04, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 79.04, "10th_percentile": 79.04, "90th_percentile": 79.04, "count": "1 through 10" } ] } ] }, { "description": "HC BLOOD VISCOSITY EXAMINATION", "code_information": [ { "code": "85810", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 180.63, "discounted_cash": 52.0, "minimum": 11.67, "maximum": 163.8314, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 96.39 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 118.11 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 94.48 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 118.11 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 118.11 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 108.19 }, { "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" } ] } ] }, { "description": "HC (SUP SHELL A4561) PESSARY RUBBER, ANY TYPE", "code_information": [ { "code": "A4561", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 28.43, "maximum": 28.43, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 28.43, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Doxycycline Hyclate For Inj 100 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "63323013002", "type": "NDC" }, { "code": "J1271", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC EDUCATION&TRAINING SELF-MGMT NONPHYS 5-8 PTS", "code_information": [ { "code": "98962", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 68.75, "discounted_cash": 19.0, "minimum": 19.9375, "maximum": 68.75, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 68.75 } ] } ] }, { "description": "HC NEG PRESS WOUND TX W DME, > 50 CM", "code_information": [ { "code": "97606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 819.69, "discounted_cash": 237.0, "minimum": 237.7101, "maximum": 743.4588, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 45.5, "10th_percentile": 45.5, "90th_percentile": 45.5, "count": "1 through 10" } ] } ] }, { "description": "CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC", "code_information": [ { "code": "074", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6276.0, "minimum": 6276.87, "maximum": 30315.978, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12152.08 } ] } ] }, { "description": "HC RADIOLOGIC EXAM ESOPHAGUS DOUBLE CONTRAST STUDY", "code_information": [ { "code": "74221", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1179.69, "discounted_cash": 342.0, "minimum": 342.1101, "maximum": 1069.9788, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 651.37 } ] } ] }, { "description": "HC (SUP SHELL C9363) SKIN SUB INTEGRA BILAYER PER SQ CM", "code_information": [ { "code": "C9363", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 216.7515, "maximum": 216.7515, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 216.75 } ] } ] }, { "description": "INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "853", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20848.0, "minimum": 20848.18, "maximum": 58221.06, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 58221.06 } ] } ] }, { "description": "GASTROINTESTINAL OBSTRUCTION WITH MCC", "code_information": [ { "code": "388", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10087.0, "minimum": 10087.83, "maximum": 17409.97, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17409.97 } ] } ] }, { "description": "HC (SUP SHELL Q4134) HMATRIX", "code_information": [ { "code": "Q4134", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 510.552, "maximum": 761.42, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 761.42 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 609.13 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 761.42 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 761.42 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 510.55 } ] } ] }, { "description": "INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC", "code_information": [ { "code": "350", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10760.0, "minimum": 10760.35, "maximum": 29376.96, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 29376.96 } ] } ] }, { "description": "HC XRAY SPINE, COMPLETE, 2-3 VW", "code_information": [ { "code": "72082", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 714.06, "discounted_cash": 207.0, "minimum": 207.0774, "maximum": 647.6524, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 468.07 } ] } ] }, { "description": "NEUROLOGICAL EYE DISORDERS", "code_information": [ { "code": "123", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4707.0, "minimum": 4707.65, "maximum": 9414.68, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9414.68 } ] } ] }, { "description": "HC LIPID PANEL", "code_information": [ { "code": "80061", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 247.5, "discounted_cash": 71.0, "minimum": 13.39, "maximum": 224.4825, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 133.71, "10th_percentile": 128.34, "90th_percentile": 144.73, "count": "44" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 68.4, "10th_percentile": 67.23, "90th_percentile": 71.28, "count": "148" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 110.63 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 135.56 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 65.89, "10th_percentile": 64.77, "90th_percentile": 68.67, "count": "149" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 108.45 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 135.56 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 135.56 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 126.13, "10th_percentile": 121.03, "90th_percentile": 126.13, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 149.61, "10th_percentile": 143.6, "90th_percentile": 155.63, "count": "83" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 124.13 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 97.04, "10th_percentile": 29.06, "90th_percentile": 186.75, "count": "95" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 43.41, "10th_percentile": 41.05, "90th_percentile": 46.02, "count": "1 through 10" }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 13.39, "10th_percentile": 13.39, "90th_percentile": 13.39, "count": "461" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 63.36, "10th_percentile": 59.76, "90th_percentile": 63.36, "count": "385" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 172.33, "10th_percentile": 158.26, "90th_percentile": 179.59, "count": "65" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 63.36, "10th_percentile": 59.76, "90th_percentile": 66.32, "count": "315" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 60.8, "10th_percentile": 60.8, "90th_percentile": 63.5, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 63.36, "10th_percentile": 59.76, "90th_percentile": 63.5, "count": "172" } ] } ] }, { "description": "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": 117.0, "minimum": 117.45, "maximum": 367.335, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 231.98, "10th_percentile": 231.98, "90th_percentile": 231.98, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 501.76, "10th_percentile": 167.26, "90th_percentile": 669.02, "count": "12" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 355.47, "10th_percentile": 355.47, "90th_percentile": 444.34, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 512.5, "10th_percentile": 82.0, "90th_percentile": 512.5, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 76.28, "10th_percentile": 38.14, "90th_percentile": 76.28, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 256.25, "10th_percentile": 256.25, "90th_percentile": 1281.25, "count": "36" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 82.0, "10th_percentile": 82.0, "90th_percentile": 245.52, "count": "29" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 256.25, "10th_percentile": 117.0, "90th_percentile": 474.06, "count": "20" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 82.0, "10th_percentile": 82.0, "90th_percentile": 164.0, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 246.0, "10th_percentile": 82.0, "90th_percentile": 328.0, "count": "30" } ] } ] }, { "description": "HC ASSAY OF BENZODIAZEPINES - G0480 - 30100410", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 352.81, "minimum": 33.0774, "maximum": 1060.8233, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 352.81 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 352.81 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 352.81 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 352.81 }, { "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": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 173.49, "10th_percentile": 173.49, "90th_percentile": 173.49, "count": "1 through 10" }, { "payer_name": "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 432.75, "10th_percentile": 164.25, "90th_percentile": 1052.5, "count": "14" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 95.76, "10th_percentile": 95.76, "90th_percentile": 95.76, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 363.48, "10th_percentile": 363.48, "90th_percentile": 375.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 132.48, "10th_percentile": 132.48, "90th_percentile": 257.04, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 132.77, "10th_percentile": 132.77, "90th_percentile": 337.54, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 55.85, "10th_percentile": 55.85, "90th_percentile": 55.85, "count": "1 through 10" } ] } ] }, { "description": "HC ASSAY OF TACROLIMUS", "code_information": [ { "code": "80197", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 304.06, "discounted_cash": 88.0, "minimum": 13.73, "maximum": 275.7824, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 87.57, "10th_percentile": 87.57, "90th_percentile": 87.57, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 60.15 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 73.7 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 79.59, "10th_percentile": 79.59, "90th_percentile": 84.36, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 58.96 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 73.7 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 73.7 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 191.19, "10th_percentile": 191.19, "90th_percentile": 191.19, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 127.28 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 56.08, "10th_percentile": 56.08, "90th_percentile": 56.08, "count": "1 through 10" }, { "payer_name": "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 229.5, "10th_percentile": 229.5, "90th_percentile": 229.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 77.84, "10th_percentile": 73.44, "90th_percentile": 78.03, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 73.44, "10th_percentile": 73.44, "90th_percentile": 77.84, "count": "1 through 10" } ] } ] }, { "description": "CESAREAN SECTION WITHOUT STERILIZATION WITH CC", "code_information": [ { "code": "787", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7621.0, "minimum": 7621.92, "maximum": 13165.93, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13165.93 } ] } ] }, { "description": "HC (SUP SHELL A6232) HYDROGEL DSG>16<=48 SQ IN", "code_information": [ { "code": "A6232", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 9.78, "maximum": 9.78, "payers_information": [ { "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" } ] } ] }, { "description": "HC ASSAY OF MERCURY", "code_information": [ { "code": "83825", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 292.81, "discounted_cash": 84.0, "minimum": 16.26, "maximum": 265.5787, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 134.2 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 164.45 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 131.56 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 164.45 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 164.45 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 150.74 }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 234.25, "10th_percentile": 234.25, "90th_percentile": 234.25, "count": "1 through 10" } ] } ] }, { "description": "WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "465", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4707.0, "minimum": 4707.65, "maximum": 21499.56, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21499.56 } ] } ] }, { "description": "HC OLIGOCLONAL IMMUNOGLOBULIN", "code_information": [ { "code": "83916", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 218.75, "discounted_cash": 63.0, "minimum": 27.39, "maximum": 218.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 165.98 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 203.38 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 162.7 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 203.38 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 203.38 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 218.75 }, { "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" } ] } ] }, { "description": "HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC", "code_information": [ { "code": "421", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7621.0, "minimum": 7621.92, "maximum": 20483.35, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20483.35 } ] } ] }, { "description": "HC X-RAY BLADDER W CONTRAST", "code_information": [ { "code": "74430", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 816.88, "discounted_cash": 236.0, "minimum": 222.7685, "maximum": 740.9102, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 246.54 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 302.09 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 241.67 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 302.09 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 302.09 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 222.77 } ] } ] }, { "description": "CESAREAN SECTION WITH STERILIZATION WITH MCC", "code_information": [ { "code": "783", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10984.0, "minimum": 10984.53, "maximum": 28943.12, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28943.12 } ] } ] }, { "description": "KCl 20 MEQ/L (0.15%) in Dextrose 5% & NaCl 0.9% Inj", "drug_information": { "unit": 1000.0, "type": "ML" }, "code_information": [ { "code": "00264765200", "type": "NDC" }, { "code": "J3480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.76, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 62.35, "10th_percentile": 62.35, "90th_percentile": 62.35, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.76 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "INTERSTITIAL LUNG DISEASE WITH MCC", "code_information": [ { "code": "196", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10760.0, "minimum": 10760.35, "maximum": 22248.16, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22248.16 } ] } ] }, { "description": "RED BLOOD CELL DISORDERS WITHOUT MCC", "code_information": [ { "code": "812", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6052.0, "minimum": 6052.7, "maximum": 10824.64, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10824.64 } ] } ] }, { "description": "HC ASSAY OF AMYLASE", "code_information": [ { "code": "82150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 154.69, "discounted_cash": 44.0, "minimum": 6.48, "maximum": 140.3038, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 123.75, "10th_percentile": 123.75, "90th_percentile": 123.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 39.6, "10th_percentile": 39.6, "90th_percentile": 39.6, "count": "12" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 39.6, "10th_percentile": 39.6, "90th_percentile": 39.6, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 42.08, "10th_percentile": 42.08, "90th_percentile": 42.08, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 44.55, "10th_percentile": 44.55, "90th_percentile": 44.55, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 53.48 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 65.53 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 52.42 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 65.53 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 65.53 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 97.27, "10th_percentile": 97.27, "90th_percentile": 97.27, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 60.07 }, { "payer_name": "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" } ] } ] }, { "description": "CARDIAC ARREST, UNEXPLAINED WITH MCC", "code_information": [ { "code": "296", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4483.0, "minimum": 4483.48, "maximum": 18413.21, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18413.21 } ] } ] }, { "description": "HC (SUP SHELL A4349) DISPOSABLE MALE EXTERNAL CAT", "code_information": [ { "code": "A4349", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2.87, "maximum": 2.87, "payers_information": [ { "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" } ] } ] }, { "description": "HC (SUP SHELL A6255) ABSORPT DRG >16<=48 IN W/BDR - A6255 - 27200144", "code_information": [ { "code": "A6255", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 4.34, "maximum": 4.34, "payers_information": [ { "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" } ] } ] }, { "description": "OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "358", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5604.0, "minimum": 5604.35, "maximum": 16479.82, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16479.82 } ] } ] }, { "description": "HC CYTOPATH TBS C/V REDO", "code_information": [ { "code": "88165", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 124.38, "discounted_cash": 36.0, "minimum": 36.0702, "maximum": 124.38, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 87.17 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 106.81 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 85.45 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 106.81 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 106.81 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 124.38 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 42.22, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF ANDROSTENEDIONE", "code_information": [ { "code": "82157", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 421.25, "discounted_cash": 122.0, "minimum": 29.28, "maximum": 382.0738, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 241.61 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 296.06 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 236.85 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 296.06 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 296.06 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 271.44 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 305.66, "10th_percentile": 305.66, "90th_percentile": 305.66, "count": "1 through 10" } ] } ] }, { "description": "OTITIS MEDIA AND URI WITH MCC", "code_information": [ { "code": "152", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7173.0, "minimum": 7173.57, "maximum": 13936.93, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13936.93 } ] } ] }, { "description": "HC (SUP SHELL L4387) NON-PNEUM WALK BOOT PRE OTS", "code_information": [ { "code": "L4387", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 190.16, "maximum": 190.16, "payers_information": [ { "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" } ] } ] }, { "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": 526.0, "minimum": 526.0774, "maximum": 1645.3524, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1247.72 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 998.17 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1247.72 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1247.72 }, { "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": 1632.66 } ] } ] }, { "description": "HC (SUP SHELL L3060) FOOT ARCH SUPP LONGITUD/META", "code_information": [ { "code": "L3060", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 88.45, "maximum": 88.45, "payers_information": [ { "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" } ] } ] }, { "description": "HC ASSAY OF PHENOTHIAZINE - 80342 - 30100385", "code_information": [ { "code": "80342", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 225.94, "discounted_cash": 65.0, "minimum": 65.5226, "maximum": 204.9276, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 129.79 } ] } ] }, { "description": "HC MRI, LUMBAR SPINE COMBO", "code_information": [ { "code": "72158", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3257.5, "discounted_cash": 944.0, "minimum": 900.0, "maximum": 2954.5525, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 938.16, "10th_percentile": 938.16, "90th_percentile": 938.16, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2670.71 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2136.55 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2670.71 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2670.71 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1869.49 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 2606.0, "10th_percentile": 2606.0, "90th_percentile": 2606.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 833.92, "10th_percentile": 833.92, "90th_percentile": 833.92, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 833.92, "10th_percentile": 833.92, "90th_percentile": 833.92, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL E0973) W/CH ACCESS DET ADJ ARMREST", "code_information": [ { "code": "E0973", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 61.55, "maximum": 61.55, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 61.55, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L4397) STATIC OR DYNAMI AFO PRE OTS", "code_information": [ { "code": "L4397", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 210.28, "maximum": 210.28, "payers_information": [ { "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" } ] } ] }, { "description": "HC ASSAY OF URINE CREATININE", "code_information": [ { "code": "82570", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 100.63, "discounted_cash": 29.0, "minimum": 5.18, "maximum": 91.2714, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 57.64, "10th_percentile": 57.64, "90th_percentile": 57.64, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 28.98, "10th_percentile": 28.98, "90th_percentile": 28.98, "count": "45" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 42.74 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 52.37 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 27.92, "10th_percentile": 27.92, "90th_percentile": 27.92, "count": "44" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 41.89 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 52.37 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 52.37 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 51.28, "10th_percentile": 51.28, "90th_percentile": 102.56, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 63.27, "10th_percentile": 63.27, "90th_percentile": 64.49, "count": "14" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 48.02 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 80.5, "10th_percentile": 10.96, "90th_percentile": 80.5, "count": "53" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 18.71, "10th_percentile": 18.71, "90th_percentile": 18.71, "count": "1 through 10" }, { "payer_name": "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 80.5, "10th_percentile": 80.5, "90th_percentile": 80.5, "count": "59" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 25.76, "10th_percentile": 25.76, "90th_percentile": 27.37, "count": "114" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 73.01, "10th_percentile": 73.01, "90th_percentile": 73.74, "count": "13" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 25.76, "10th_percentile": 25.76, "90th_percentile": 29.79, "count": "113" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 25.76, "10th_percentile": 25.76, "90th_percentile": 25.76, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 25.76, "10th_percentile": 25.76, "90th_percentile": 27.37, "count": "61" } ] } ] }, { "description": "HC ASSAY FOR CALPROTECTIN FECAL", "code_information": [ { "code": "83993", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 462.5, "discounted_cash": 134.0, "minimum": 19.63, "maximum": 419.4875, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 264.92, "10th_percentile": 264.92, "90th_percentile": 264.92, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 133.2, "10th_percentile": 133.2, "90th_percentile": 133.2, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 162.02 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 198.53 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 128.32, "10th_percentile": 128.32, "90th_percentile": 128.32, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 158.82 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 198.53 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 198.53 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 235.69, "10th_percentile": 235.69, "90th_percentile": 235.69, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 296.41, "10th_percentile": 296.41, "90th_percentile": 296.41, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 181.98 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 370.0, "10th_percentile": 370.0, "90th_percentile": 370.0, "count": "22" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 118.4, "10th_percentile": 19.63, "90th_percentile": 118.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 335.59, "10th_percentile": 335.59, "90th_percentile": 335.59, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 118.4, "10th_percentile": 118.4, "90th_percentile": 118.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 118.4, "10th_percentile": 19.63, "90th_percentile": 125.8, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 118.4, "10th_percentile": 118.4, "90th_percentile": 118.4, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL Q4196) PURAPLY PER SQ CM", "code_information": [ { "code": "Q4196", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 332.199, "maximum": 495.43, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 495.43 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 396.34 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 495.43 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 495.43 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 332.2 } ] } ] }, { "description": "EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC", "code_information": [ { "code": "981", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18830.0, "minimum": 18830.62, "maximum": 55311.54, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 55311.54 } ] } ] }, { "description": "HC TUMOR IMAGING, LIMITED AREA", "code_information": [ { "code": "78800", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1966.25, "discounted_cash": 570.0, "minimum": 570.2125, "maximum": 1783.3888, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 595.21 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 729.33 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 583.46 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 729.33 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 729.33 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1708.8 } ] } ] }, { "description": "EPISTAXIS WITH MCC", "code_information": [ { "code": "150", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7621.0, "minimum": 7621.92, "maximum": 15697.03, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15697.03 } ] } ] }, { "description": "HC (SUP SHELL A6253) ABSORPT DRG > 48 SQ IN W/O B - A6253 - RU272055", "code_information": [ { "code": "A6253", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 9.03, "maximum": 9.03, "payers_information": [ { "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" } ] } ] }, { "description": "HC ANGIO AORTOGRAM THORACIC", "code_information": [ { "code": "75600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8860.31, "discounted_cash": 2569.0, "minimum": 1174.07, "maximum": 8036.3012, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1197.69 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1467.59 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1174.07 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1467.59 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1467.59 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1347.88 } ] } ] }, { "description": "PERITONEAL ADHESIOLYSIS WITHOUT CCMCC", "code_information": [ { "code": "337", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6725.0, "minimum": 6725.22, "maximum": 18096.08, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18096.08 } ] } ] }, { "description": "RED BLOOD CELL DISORDERS WITH MCC", "code_information": [ { "code": "811", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8294.0, "minimum": 8294.44, "maximum": 16555.26, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16555.26 } ] } ] }, { "description": "Benztropine Mesylate Inj 1 MG/ML", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "00143972901", "type": "NDC" }, { "code": "J0515", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 52.8255, "maximum": 245.17, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 245.17 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 78.78 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 63.03 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 78.78 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 78.78 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 52.83 } ] } ] }, { "description": "HC X-RAYS, BONE SURVEY, INFANT", "code_information": [ { "code": "77076", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 344.38, "discounted_cash": 99.0, "minimum": 99.8702, "maximum": 344.38, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 234.89 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 287.82 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 230.25 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 287.82 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 287.82 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 344.38 } ] } ] }, { "description": "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC", "code_information": [ { "code": "147", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7846.0, "minimum": 7846.09, "maximum": 14989.69, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14989.69 } ] } ] }, { "description": "HC (SUP SHELL A4221) SUPP NON-INSULIN INF CATH/WK", "code_information": [ { "code": "A4221", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 25.87, "maximum": 25.87, "payers_information": [ { "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" } ] } ] }, { "description": "DIABETES WITH CC", "code_information": [ { "code": "638", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6501.0, "minimum": 6501.05, "maximum": 23496.3302, "payers_information": [ { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 20520.13, "standard_charge_algorithm": "78.6% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 18774.32, "10th_percentile": 18774.32, "90th_percentile": 18774.32, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 6501.05, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 6431.46, "10th_percentile": 6431.46, "90th_percentile": 6431.46, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10565.28 } ] } ] }, { "description": "HC ASSAY FOR COLLAGEN CROSS LINKS", "code_information": [ { "code": "82523", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 313.13, "discounted_cash": 90.0, "minimum": 18.68, "maximum": 284.0089, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 105.2 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 128.91 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 103.13 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 128.91 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 128.91 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 173.17 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Propofol IV Emul 100 MG/10ML (10 MG/ML)", "drug_information": { "unit": 20.0, "type": "ML" }, "code_information": [ { "code": "63323026929", "type": "NDC" }, { "code": "J2704", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.76, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.76 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC FIBRINOLYTIC PLASMINOGEN", "code_information": [ { "code": "85415", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 241.25, "discounted_cash": 69.0, "minimum": 17.19, "maximum": 218.8137, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 141.89 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 173.87 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 139.09 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 173.87 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 173.87 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 159.36 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC OCCUP THRP EVAL, HIGH COMPLEXITY, 60 MIN", "code_information": [ { "code": "97167", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 626.88, "discounted_cash": 181.0, "minimum": 95.0, "maximum": 568.5802, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 96.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 160.48, "10th_percentile": 160.48, "90th_percentile": 160.48, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 160.48, "10th_percentile": 160.48, "90th_percentile": 160.48, "count": "1 through 10" } ] } ] }, { "description": "HC MR ANGIO, HEAD", "code_information": [ { "code": "70544", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2406.88, "discounted_cash": 697.0, "minimum": 697.9952, "maximum": 2183.0402, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1725.03 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1380.01 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1725.03 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1725.03 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 1542.52, "10th_percentile": 1542.52, "90th_percentile": 1542.52, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1401.42 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1925.5, "10th_percentile": 1925.5, "90th_percentile": 1925.5, "count": "1 through 10" } ] } ] }, { "description": "MAJOR SKIN DISORDERS WITHOUT MCC", "code_information": [ { "code": "596", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7621.0, "minimum": 7621.92, "maximum": 12761.57, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12761.57 } ] } ] }, { "description": "HC BORDETELLA ANTIBODY", "code_information": [ { "code": "86615", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 580.0, "discounted_cash": 168.0, "minimum": 13.19, "maximum": 526.06, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 108.82 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 133.34 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 106.68 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 133.34 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 133.34 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 122.28 }, { "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" } ] } ] }, { "description": "HC ASSAY OF PHENOTHIAZINE - G0480 - 30100385", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 225.94, "minimum": 33.0774, "maximum": 1060.8233, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 432.75, "10th_percentile": 164.25, "90th_percentile": 1052.5, "count": "14" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 95.76, "10th_percentile": 95.76, "90th_percentile": 95.76, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 363.48, "10th_percentile": 363.48, "90th_percentile": 375.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 132.48, "10th_percentile": 132.48, "90th_percentile": 257.04, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 132.77, "10th_percentile": 132.77, "90th_percentile": 337.54, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 55.85, "10th_percentile": 55.85, "90th_percentile": 55.85, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 225.94 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 225.94 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 225.94 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 225.94 }, { "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": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 173.49, "10th_percentile": 173.49, "90th_percentile": 173.49, "count": "1 through 10" }, { "payer_name": "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" } ] } ] }, { "description": "HC (SUP SHELL A6449) LT COMPRES BAND >=3 <5/YD - A6449 - 27090039", "code_information": [ { "code": "A6449", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2.5, "maximum": 2.5, "payers_information": [ { "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" } ] } ] }, { "description": "HC (SUP SHELL C1769) GUIDE WIRE", "code_information": [ { "code": "C1769", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 447.59, "10th_percentile": 447.59, "90th_percentile": 447.59, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 20.3, "10th_percentile": 20.3, "90th_percentile": 20.3, "count": "1 through 10" } ] } ] }, { "description": "HC DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/O CNTRST", "code_information": [ { "code": "71250", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2460.63, "discounted_cash": 713.0, "minimum": 650.0, "maximum": 2231.7914, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 1213.26, "10th_percentile": 1213.26, "90th_percentile": 1213.26, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 646.65, "10th_percentile": 610.02, "90th_percentile": 646.65, "count": "15" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 963.52 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 622.94, "10th_percentile": 587.65, "90th_percentile": 622.94, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 770.82 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 963.52 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 963.52 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 724.71 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 574.8, "10th_percentile": 574.8, "90th_percentile": 576.13, "count": "31" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1796.25, "10th_percentile": 1694.5, "90th_percentile": 1796.25, "count": "26" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 574.8, "10th_percentile": 542.24, "90th_percentile": 574.8, "count": "42" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 1629.2, "10th_percentile": 1629.2, "90th_percentile": 1629.2, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 574.8, "10th_percentile": 542.24, "90th_percentile": 574.8, "count": "36" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 576.13, "10th_percentile": 574.8, "90th_percentile": 576.13, "count": "51" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 574.8, "10th_percentile": 542.24, "90th_percentile": 576.13, "count": "18" } ] } ] }, { "description": "HC (SUP SHELL Q4102) OASIS WOUND MATRIX PER SQ CM", "code_information": [ { "code": "Q4102", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 37.8315, "maximum": 165.05, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 165.05 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 56.42 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 45.14 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 56.42 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 56.42 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.83 } ] } ] }, { "description": "HC (SUP SHELL A6448) LT COMPRES BAND <3/YD - A6448 - 27100024", "code_information": [ { "code": "A6448", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.64, "maximum": 1.64, "payers_information": [ { "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" } ] } ] }, { "description": "HC DEVEL TST PHYS/QHP EA ADDL", "code_information": [ { "code": "96113", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 290.31, "discounted_cash": 84.0, "minimum": 84.1899, "maximum": 263.3112, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC", "code_information": [ { "code": "256", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11208.0, "minimum": 11208.7, "maximum": 20016.51, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20016.51 } ] } ] }, { "description": "DIGESTIVE MALIGNANCY WITH MCC", "code_information": [ { "code": "374", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12329.0, "minimum": 12329.57, "maximum": 25213.09, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25213.09 } ] } ] }, { "description": "HYPERTENSION WITH MCC", "code_information": [ { "code": "304", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6949.0, "minimum": 6949.39, "maximum": 14028.89, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14028.89 } ] } ] }, { "description": "HC VKORC1 GENE ANALYSIS COMMON VARIANT(S)", "code_information": [ { "code": "81355", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 784.38, "discounted_cash": 227.0, "minimum": 88.2, "maximum": 784.38, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 371.8 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 455.59 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 364.47 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 455.59 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 455.59 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 784.38 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 88.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC MRA LOWER EXTREM W CONTRAST - C8912 - 61600001", "code_information": [ { "code": "C8912", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4708.75, "minimum": 900.0, "maximum": 4270.8363, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 } ] } ] }, { "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": 109.0, "minimum": 109.5649, "maximum": 372.1914, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 170.69 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 209.16 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 167.33 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 209.16 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 209.16 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 372.19 } ] } ] }, { "description": "HC (SUP SHELL A4389) DRAINABLE PCH W ST WEAR BARR", "code_information": [ { "code": "A4389", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 8.84, "maximum": 8.84, "payers_information": [ { "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" } ] } ] }, { "description": "Dexamethasone Tab 0.5 MG", "drug_information": { "unit": 100.0, "type": "EA" }, "code_information": [ { "code": "00054417925", "type": "NDC" }, { "code": "J8540", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.34, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.34 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC NM TEAR FLOW EXAM", "code_information": [ { "code": "78660", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1237.5, "discounted_cash": 358.0, "minimum": 358.875, "maximum": 1122.4125, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 538.3 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 659.6 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 527.68 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 659.6 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 659.6 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 947.41 } ] } ] }, { "description": "HC KETONE BODIES SERUM QUANTITATIVE", "code_information": [ { "code": "82010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 97.19, "discounted_cash": 28.0, "minimum": 8.17, "maximum": 88.1513, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 67.44 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 82.64 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 26.97, "10th_percentile": 26.97, "90th_percentile": 26.97, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 66.11 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 82.64 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 82.64 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 75.74 }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 77.75, "10th_percentile": 77.75, "90th_percentile": 77.75, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 24.88, "10th_percentile": 24.88, "90th_percentile": 26.44, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 24.88, "10th_percentile": 24.88, "90th_percentile": 28.77, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 24.88, "10th_percentile": 24.88, "90th_percentile": 26.44, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 24.88, "10th_percentile": 24.88, "90th_percentile": 24.88, "count": "1 through 10" } ] } ] }, { "description": "DISORDERS OF THE BILIARY TRACT WITHOUT CCMCC", "code_information": [ { "code": "446", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4707.0, "minimum": 4707.65, "maximum": 9753.02, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9753.02 } ] } ] }, { "description": "HC CANALITH REPOSITIONING PER DAY", "code_information": [ { "code": "95992", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 170.94, "discounted_cash": 49.0, "minimum": 29.1, "maximum": 155.0426, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "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" } ] } ] }, { "description": "HC MRI ABDOMEN WO/W CONTRAST", "code_information": [ { "code": "74183", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3609.06, "discounted_cash": 1046.0, "minimum": 900.0, "maximum": 3273.4174, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2670.71 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2136.55 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2670.71 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2670.71 }, { "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": 2072.53 } ] } ] }, { "description": "MAJOR HEAD AND NECK PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "142", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4259.0, "minimum": 4259.31, "maximum": 18819.93, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18819.93 } ] } ] }, { "description": "HC (SUP SHELL A6238) HYDROCOLLD DRG >16<=48 W/BDR", "code_information": [ { "code": "A6238", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 32.5, "maximum": 32.5, "payers_information": [ { "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" } ] } ] }, { "description": "HC (SUP SHELL A4362) SOLID SKIN BARRIER", "code_information": [ { "code": "A4362", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 4.51, "maximum": 4.51, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.51, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC HEPATIC FUNCTION PANEL", "code_information": [ { "code": "80076", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 286.56, "discounted_cash": 83.0, "minimum": 8.17, "maximum": 259.9099, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 154.84, "10th_percentile": 154.84, "90th_percentile": 154.84, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 77.85, "10th_percentile": 8.17, "90th_percentile": 82.53, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 67.44 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 82.64 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 79.51, "10th_percentile": 75.0, "90th_percentile": 79.51, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 66.11 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 82.64 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 82.64 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 146.03, "10th_percentile": 146.03, "90th_percentile": 146.03, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 180.19, "10th_percentile": 180.19, "90th_percentile": 180.19, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 75.74 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 81.76, "10th_percentile": 73.53, "90th_percentile": 114.96, "count": "1 through 10" }, { "payer_name": "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 229.25, "10th_percentile": 216.25, "90th_percentile": 229.25, "count": "34" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 73.36, "10th_percentile": 8.17, "90th_percentile": 73.53, "count": "18" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 207.93, "10th_percentile": 207.93, "90th_percentile": 207.93, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 73.36, "10th_percentile": 69.2, "90th_percentile": 73.36, "count": "16" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 73.36, "10th_percentile": 73.36, "90th_percentile": 73.36, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 73.36, "10th_percentile": 69.2, "90th_percentile": 73.53, "count": "13" } ] } ] }, { "description": "HC CULTURE ANAEROBE IDENT EACH", "code_information": [ { "code": "87076", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 53.13, "discounted_cash": 15.0, "minimum": 8.08, "maximum": 53.13, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 43.13 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 52.85 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 42.28 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 52.85 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 52.85 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 53.13 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 40.0, "10th_percentile": 40.0, "90th_percentile": 42.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 13.6, "10th_percentile": 13.6, "90th_percentile": 13.6, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 40.8, "10th_percentile": 40.8, "90th_percentile": 40.8, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 13.6, "10th_percentile": 13.6, "90th_percentile": 13.6, "count": "1 through 10" } ] } ] }, { "description": "HC Q FEVER ANTIBODY", "code_information": [ { "code": "86638", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 366.56, "discounted_cash": 106.0, "minimum": 12.12, "maximum": 332.4699, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 100.06 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 122.61 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 98.09 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 122.61 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 122.61 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 112.36 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "100.00% 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": 69.0, "minimum": 15.6, "maximum": 216.8274, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 94.58 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 115.89 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 92.71 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 115.89 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 115.89 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 144.62 }, { "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" } ] } ] }, { "description": "HC MACROSCOPIC EXAM, ARTHROPOD", "code_information": [ { "code": "87168", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40.63, "discounted_cash": 11.0, "minimum": 4.27, "maximum": 40.63, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 35.22 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 40.63 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 34.52 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 40.63 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 40.63 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.59 }, { "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": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 10.4, "10th_percentile": 10.4, "90th_percentile": 10.4, "count": "1 through 10" } ] } ] }, { "description": "HC BLOOD OCCULT STOOL, 1-3 SIMULT, NON CAN SCREEN", "code_information": [ { "code": "82272", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 55.0, "discounted_cash": 15.0, "minimum": 4.23, "maximum": 49.885, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 15.84, "10th_percentile": 15.84, "90th_percentile": 15.84, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 26.85 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 32.9 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 15.26, "10th_percentile": 15.26, "90th_percentile": 15.26, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 32.9 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 32.9 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.21 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 4.23, "10th_percentile": 4.23, "90th_percentile": 44.0, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 44.0, "10th_percentile": 44.0, "90th_percentile": 44.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 14.08, "10th_percentile": 14.08, "90th_percentile": 14.08, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 14.08, "10th_percentile": 14.08, "90th_percentile": 14.08, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 14.08, "10th_percentile": 4.23, "90th_percentile": 14.08, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 14.08, "10th_percentile": 14.08, "90th_percentile": 14.96, "count": "1 through 10" } ] } ] }, { "description": "OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "819", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3586.0, "minimum": 3586.78, "maximum": 10137.34, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10137.34 } ] } ] }, { "description": "Leuprolide Acetate (6 Month) For Subcutaneous Inj Kit 45 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "62935046150", "type": "NDC" }, { "code": "J9217", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 542.7135, "maximum": 3206.67, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 2847.34, "10th_percentile": 2847.34, "90th_percentile": 2847.34, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3206.67 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 809.38 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 647.5 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 809.38 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 809.38 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 542.71 } ] } ] }, { "description": "HC CT SCAN DORSAL SP CONTRAST", "code_information": [ { "code": "72129", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2300.63, "discounted_cash": 667.0, "minimum": 650.0, "maximum": 2086.6714, "payers_information": [ { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1383.58 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 989.76 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1383.58 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1106.86 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1383.58 } ] } ] }, { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC", "code_information": [ { "code": "438", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10312.0, "minimum": 9704.6707, "maximum": 19218.4, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19218.4 } ] } ] }, { "description": "HC (SUP SHELL Q4166) CYTAL, PER SQUARE CENTIMETER", "code_information": [ { "code": "Q4166", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 67.725, "maximum": 101.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 101.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 80.8 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 101.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 101.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 67.73 } ] } ] }, { "description": "HC GLUCOSE TOLERANCE TEST (GTT)", "code_information": [ { "code": "82951", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 208.44, "discounted_cash": 60.0, "minimum": 12.87, "maximum": 189.0551, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 119.39, "10th_percentile": 119.39, "90th_percentile": 119.39, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 106.28 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 130.23 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 104.18 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 130.23 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 130.23 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 119.31 }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 12.87, "10th_percentile": 12.87, "90th_percentile": 12.87, "count": "1 through 10" } ] } ] }, { "description": "OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "145", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3586.0, "minimum": 3586.78, "maximum": 14173.89, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14173.89 } ] } ] }, { "description": "HC ASSAY OF SWEAT SODIUM", "code_information": [ { "code": "84302", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 87.5, "discounted_cash": 25.0, "minimum": 4.86, "maximum": 79.3625, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 40.14 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 49.18 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 39.35 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 49.18 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 49.18 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 45.05 }, { "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" } ] } ] }, { "description": "HC RADIOPHARMACEUTICAL QUANTIFICATION MEAS 1 AREA", "code_information": [ { "code": "78835", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1122.19, "discounted_cash": 325.0, "minimum": 325.4351, "maximum": 1017.8263, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 578.02 } ] } ] }, { "description": "FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES", "code_information": [ { "code": "748", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3138.0, "minimum": 3138.44, "maximum": 16354.85, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16354.85 } ] } ] }, { "description": "HC (SUP SHELL Q4159) AFFINITY", "code_information": [ { "code": "Q4159", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 828.2295, "maximum": 12886.48, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12886.48 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1235.19 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 988.14 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1235.19 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1235.19 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 828.23 } ] } ] }, { "description": "HC URINALYSIS NONAUTO W/O SCOPE", "code_information": [ { "code": "81002", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 68.75, "discounted_cash": 19.0, "minimum": 3.48, "maximum": 62.3563, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 10.98, "10th_percentile": 10.98, "90th_percentile": 10.98, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 21.14 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.91 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 10.58, "10th_percentile": 10.58, "90th_percentile": 10.58, "count": "12" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 20.73 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 25.91 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 25.91 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.26 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 3.48, "10th_percentile": 3.48, "90th_percentile": 9.76, "count": "12" }, { "payer_name": "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 30.5, "10th_percentile": 30.5, "90th_percentile": 30.5, "count": "98" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 9.76, "10th_percentile": 3.48, "90th_percentile": 9.76, "count": "37" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 9.76, "10th_percentile": 9.76, "90th_percentile": 11.29, "count": "31" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 9.76, "10th_percentile": 9.76, "90th_percentile": 10.37, "count": "18" } ] } ] }, { "description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC", "code_information": [ { "code": "564", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10760.0, "minimum": 10760.35, "maximum": 18197.47, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18197.47 } ] } ] }, { "description": "Phentolamine Mesylate For Inj 5 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00143956401", "type": "NDC" }, { "code": "J2760", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1415.295, "maximum": 6332.63, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6332.63 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2110.72 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1688.56 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2110.72 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2110.72 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1415.3 } ] } ] }, { "description": "Atropine Sulfate Soln Prefill Syr 0.5 MG/5ML (0.1 MG/ML)", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "64253040030", "type": "NDC" }, { "code": "J0461", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.04, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.04 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD", "code_information": [ { "code": "81340", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1025.0, "discounted_cash": 297.0, "minimum": 208.92, "maximum": 1025.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 898.33 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1025.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 880.62 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1025.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1025.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1025.0 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 208.92, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC BILIRUBIN TOTAL TRANSCUTANEOUS", "code_information": [ { "code": "88720", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 39.06, "discounted_cash": 11.0, "minimum": 5.02, "maximum": 39.06, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 39.06 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 39.06 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 39.06 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 39.06 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 39.06 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.06 }, { "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" } ] } ] }, { "description": "HC ASSAY OF BLOOD OSMOLALITY", "code_information": [ { "code": "83930", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 110.94, "discounted_cash": 32.0, "minimum": 6.61, "maximum": 100.6226, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 54.55 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 66.85 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 30.78, "10th_percentile": 30.78, "90th_percentile": 30.78, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 53.48 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 66.85 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 66.85 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 61.28 }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 88.75, "10th_percentile": 88.75, "90th_percentile": 88.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 28.4, "10th_percentile": 28.4, "90th_percentile": 28.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 28.4, "10th_percentile": 28.4, "90th_percentile": 28.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 28.4, "10th_percentile": 28.4, "90th_percentile": 28.4, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 28.4, "10th_percentile": 28.4, "90th_percentile": 28.4, "count": "1 through 10" } ] } ] }, { "description": "MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC", "code_information": [ { "code": "345", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8966.0, "minimum": 8966.96, "maximum": 17738.88, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17738.88 } ] } ] }, { "description": "HC (SUP SHELL Q4137) AMNIOEXCEL OR BIODEXCEL", "code_information": [ { "code": "Q4137", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 321.867, "maximum": 2373.74, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2373.74 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 480.02 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 384.01 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 480.02 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 480.02 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 321.87 } ] } ] }, { "description": "Dexamethasone Tab 4 MG", "drug_information": { "unit": 100.0, "type": "EA" }, "code_information": [ { "code": "00054817525", "type": "NDC" }, { "code": "J8540", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.34, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.34 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC", "code_information": [ { "code": "283", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7173.0, "minimum": 7173.57, "maximum": 23351.61, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23351.61 } ] } ] }, { "description": "HC SURG PATH,LEVEL II", "code_information": [ { "code": "88302", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 515.0, "discounted_cash": 149.0, "minimum": 149.35, "maximum": 467.105, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 306.2 } ] } ] }, { "description": "HC MASSAGE THERAPY EA 15 MIN", "code_information": [ { "code": "97124", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 202.5, "discounted_cash": 58.0, "minimum": 28.18, "maximum": 183.6675, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "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" } ] } ] }, { "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": 91.0, "minimum": 91.7125, "maximum": 316.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 223.43 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 178.75 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 223.43 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 223.43 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 316.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 316.25 } ] } ] }, { "description": "LUNG TRANSPLANT", "code_information": [ { "code": "007", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 44162.0, "minimum": 44162.28, "maximum": 152669.65, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 152669.65 } ] } ] }, { "description": "HC (SUP SHELL A6453) SELF-ADHER BAND W <3/YD - A6453 - 27100096", "code_information": [ { "code": "A6453", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "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" } ] } ] }, { "description": "HC MOPATH PROCEDURE LEVEL 1", "code_information": [ { "code": "81400", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 757.81, "discounted_cash": 219.0, "minimum": 63.96, "maximum": 687.3337, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 259.19 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 317.6 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 254.08 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 317.6 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 317.6 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 592.94 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 63.96, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF PREALBUMIN", "code_information": [ { "code": "84134", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 130.31, "discounted_cash": 37.0, "minimum": 14.59, "maximum": 130.31, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 120.41 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 130.31 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 118.04 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 130.31 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 130.31 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 130.31 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 104.25, "10th_percentile": 104.25, "90th_percentile": 104.25, "count": "1 through 10" }, { "payer_name": "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 104.25, "10th_percentile": 104.25, "90th_percentile": 104.25, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 35.45, "10th_percentile": 35.45, "90th_percentile": 35.45, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 35.45, "10th_percentile": 33.36, "90th_percentile": 35.45, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL A6222) GAUZE <=16 IN NO W/SAL W/O B - A6222 - RU272010", "code_information": [ { "code": "A6222", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 3.04, "maximum": 3.04, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3.04, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Dronabinol Cap 2.5 MG", "drug_information": { "unit": 100.0, "type": "EA" }, "code_information": [ { "code": "00904714461", "type": "NDC" }, { "code": "Q0167", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 4.662, "maximum": 47.04, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 47.04 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.95 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5.56 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 6.95 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 6.95 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.66 } ] } ] }, { "description": "HC ANTIDEPRESSANTS NOT OTHERWISE SPECIFIED - 80338 - 31080338", "code_information": [ { "code": "80338", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 438.13, "discounted_cash": 127.0, "minimum": 118.1989, "maximum": 397.3839, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 118.2 } ] } ] }, { "description": "HC FATS/LIPIDS, FECES, QUALITATIVE", "code_information": [ { "code": "82705", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 177.19, "discounted_cash": 51.0, "minimum": 5.1, "maximum": 160.7113, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 42.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 51.47 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 41.17 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 51.47 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 51.47 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 47.28 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 5.1, "10th_percentile": 5.1, "90th_percentile": 5.1, "count": "1 through 10" } ] } ] }, { "description": "HC CANNABINOIDS NATURAL ASSAY - 80349 - 30100418", "code_information": [ { "code": "80349", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 429.69, "discounted_cash": 124.0, "minimum": 124.4101, "maximum": 389.7288, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 124.41 } ] } ] }, { "description": "Fluconazole in NaCl 0.9% Inj 400 MG/200ML", "drug_information": { "unit": 200.0, "type": "ML" }, "code_information": [ { "code": "25021018487", "type": "NDC" }, { "code": "J1450", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 11.277, "maximum": 65.98, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 65.98 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.82 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13.45 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 16.82 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 16.82 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.28 } ] } ] }, { "description": "HC (SUP SHELL L3760) EO WITHJOINT, PREFABRICATED", "code_information": [ { "code": "L3760", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 545.9, "maximum": 545.9, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 545.9, "additional_payer_notes": "100.00% 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": 6276.0, "minimum": 6276.87, "maximum": 19350.43, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19350.43 } ] } ] }, { "description": "MAJOR CHEST TRAUMA WITH CC", "code_information": [ { "code": "184", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6949.0, "minimum": 4903.7875, "maximum": 12544.65, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12544.65 } ] } ] }, { "description": "CERVICAL SPINAL FUSION WITH MCC", "code_information": [ { "code": "471", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15916.0, "minimum": 15916.35, "maximum": 56925.45, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 56925.45 } ] } ] }, { "description": "HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CCMCC", "code_information": [ { "code": "355", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4035.0, "minimum": 4035.13, "maximum": 15856.18, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15856.18 } ] } ] }, { "description": "HC X-RAY NASAL BONES", "code_information": [ { "code": "70160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 487.81, "discounted_cash": 141.0, "minimum": 90.09, "maximum": 442.4437, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 91.9 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 112.61 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 90.09 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 112.61 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 112.61 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 250.97 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 390.25, "10th_percentile": 390.25, "90th_percentile": 390.25, "count": "1 through 10" } ] } ] }, { "description": "HC ASSAY OF GASTRIN", "code_information": [ { "code": "82941", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 190.31, "discounted_cash": 55.0, "minimum": 17.63, "maximum": 178.37, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 145.57 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 178.37 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 142.7 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 178.37 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 178.37 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 163.44 }, { "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": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 48.72, "10th_percentile": 48.72, "90th_percentile": 48.72, "count": "1 through 10" } ] } ] }, { "description": "HC CT SCAN ABDOMEN/PELVIS COMBO", "code_information": [ { "code": "74178", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3903.13, "discounted_cash": 1131.0, "minimum": 650.0, "maximum": 3540.1389, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1748.27 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 871.16, "10th_percentile": 871.16, "90th_percentile": 871.16, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1398.61 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1748.27 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1748.27 }, { "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": 2162.74 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 718.84, "10th_percentile": 718.84, "90th_percentile": 1293.64, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 2369.75, "10th_percentile": 2369.75, "90th_percentile": 2512.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 758.32, "10th_percentile": 758.32, "90th_percentile": 803.84, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 803.84, "10th_percentile": 803.84, "90th_percentile": 803.84, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 803.84, "10th_percentile": 803.84, "90th_percentile": 803.84, "count": "1 through 10" } ] } ] }, { "description": "HC PROTEIN TOT XCPT REFRACTOMETRY URINE", "code_information": [ { "code": "84156", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 101.25, "discounted_cash": 29.0, "minimum": 3.67, "maximum": 91.8337, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 18.0, "10th_percentile": 18.0, "90th_percentile": 29.16, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 30.24 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 37.06 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 29.65 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 37.06 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 37.06 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 40.93, "10th_percentile": 40.93, "90th_percentile": 40.93, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.02 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 81.0, "10th_percentile": 81.0, "90th_percentile": 81.0, "count": "1 through 10" }, { "payer_name": "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 81.0, "10th_percentile": 81.0, "90th_percentile": 81.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 3.67, "10th_percentile": 3.67, "90th_percentile": 3.67, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 24.72, "10th_percentile": 16.0, "90th_percentile": 28.58, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 27.54, "10th_percentile": 27.54, "90th_percentile": 27.54, "count": "1 through 10" } ] } ] }, { "description": "HC ASSAY OF VITAMIN A", "code_information": [ { "code": "84590", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 199.06, "discounted_cash": 57.0, "minimum": 11.61, "maximum": 180.5474, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 114.02, "10th_percentile": 114.02, "90th_percentile": 114.02, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 95.71 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 117.27 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 93.82 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 117.27 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 117.27 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 101.44, "10th_percentile": 101.44, "90th_percentile": 101.44, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 127.58, "10th_percentile": 127.58, "90th_percentile": 127.58, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 107.63 }, { "payer_name": "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 159.25, "10th_percentile": 159.25, "90th_percentile": 159.25, "count": "16" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 50.96, "10th_percentile": 50.96, "90th_percentile": 50.96, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 50.96, "10th_percentile": 50.96, "90th_percentile": 50.96, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 50.96, "10th_percentile": 50.96, "90th_percentile": 54.15, "count": "1 through 10" } ] } ] }, { "description": "HC IMMUNIZ ADMIN, INJ, INIT VAC", "code_information": [ { "code": "90471", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26.88, "discounted_cash": 7.0, "minimum": 7.7952, "maximum": 24.3802, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 16.51, "10th_percentile": 16.51, "90th_percentile": 16.66, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 7.74, "10th_percentile": 7.74, "90th_percentile": 7.74, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 13.77, "10th_percentile": 13.77, "90th_percentile": 13.77, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 7.46, "10th_percentile": 7.46, "90th_percentile": 7.46, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.1, "median_amount": 17.63, "10th_percentile": 17.22, "90th_percentile": 17.63, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 79.93, "median_amount": 17.18, "10th_percentile": 17.18, "90th_percentile": 17.18, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 21.5, "10th_percentile": 21.5, "90th_percentile": 21.5, "count": "56" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 6.88, "10th_percentile": 6.88, "90th_percentile": 6.88, "count": "22" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 17.18, "10th_percentile": 17.18, "90th_percentile": 19.69, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 6.88, "10th_percentile": 6.88, "90th_percentile": 6.88, "count": "13" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 6.88, "10th_percentile": 6.88, "90th_percentile": 6.88, "count": "11" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 6.88, "10th_percentile": 6.88, "90th_percentile": 7.31, "count": "1 through 10" } ] } ] }, { "description": "HC ROTAVIRUS AG, EIA", "code_information": [ { "code": "87425", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 360.31, "discounted_cash": 104.0, "minimum": 11.98, "maximum": 326.8012, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 94.58 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 115.89 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 92.71 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 115.89 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 115.89 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 111.06 }, { "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" } ] } ] }, { "description": "HC X-RAY TOMOGRAM", "code_information": [ { "code": "76100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 802.81, "discounted_cash": 232.0, "minimum": 232.8149, "maximum": 728.1487, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 300.54 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 368.26 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 294.61 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 368.26 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 368.26 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 524.48 } ] } ] }, { "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": 185.0, "minimum": 95.0, "maximum": 578.7839, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "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" } ] } ] }, { "description": "HC (SUP SHELL Q4117) HYALOMATRIX", "code_information": [ { "code": "Q4117", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 53.2665, "maximum": 192.38, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 192.38 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 79.44 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 63.55 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 79.44 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 79.44 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 53.27 } ] } ] }, { "description": "HC URINALYSIS, AUTO, W/O SCOPE", "code_information": [ { "code": "81003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 63.13, "discounted_cash": 18.0, "minimum": 2.25, "maximum": 57.2589, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 36.16, "10th_percentile": 33.12, "90th_percentile": 36.16, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 18.18, "10th_percentile": 16.65, "90th_percentile": 23.31, "count": "24" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.54 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.72 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 17.51, "10th_percentile": 16.04, "90th_percentile": 17.51, "count": "26" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 18.18 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 22.72 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 22.72 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 40.45, "10th_percentile": 32.17, "90th_percentile": 41.41, "count": "12" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.86 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 17.17, "count": "11" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 50.5, "10th_percentile": 46.25, "90th_percentile": 50.5, "count": "194" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 16.16, "10th_percentile": 2.25, "90th_percentile": 17.17, "count": "80" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 45.8, "10th_percentile": 36.97, "90th_percentile": 46.26, "count": "12" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 16.16, "10th_percentile": 14.8, "90th_percentile": 20.72, "count": "57" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 16.16, "10th_percentile": 14.8, "90th_percentile": 17.17, "count": "30" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 16.16, "10th_percentile": 14.8, "90th_percentile": 20.72, "count": "19" } ] } ] }, { "description": "HC IGK@ GENE REARRANGE DETECT ABNORMAL CLONAL POP", "code_information": [ { "code": "81264", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 875.0, "discounted_cash": 253.0, "minimum": 172.73, "maximum": 875.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 875.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 875.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 875.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 875.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 875.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 875.0 }, { "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" } ] } ] }, { "description": "HC US,TRANSRECTAL", "code_information": [ { "code": "76872", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 780.0, "discounted_cash": 226.0, "minimum": 226.2, "maximum": 780.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 484.44 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 387.55 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 484.44 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 484.44 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 780.0 } ] } ] }, { "description": "MALIGNANT BREAST DISORDERS WITH CC", "code_information": [ { "code": "598", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7621.0, "minimum": 7621.92, "maximum": 13336.87, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13336.87 } ] } ] }, { "description": "HC VENOGRAM SUPER VENA CAVA", "code_information": [ { "code": "75827", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2807.19, "discounted_cash": 814.0, "minimum": 558.2871, "maximum": 2546.1213, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 834.46 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1022.51 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 818.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1022.51 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1022.51 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 558.29 } ] } ] }, { "description": "HC REMOVE,OBST MATL,CVA DEV VIA LUMEN", "code_information": [ { "code": "75902", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1305.94, "discounted_cash": 378.0, "minimum": 324.62, "maximum": 1184.4876, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 331.16 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 405.78 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 324.62 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 405.78 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 405.78 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 592.16 } ] } ] }, { "description": "HC XRAY HIPS W PELVIS, BILAT 2 VW", "code_information": [ { "code": "73521", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 714.06, "discounted_cash": 207.0, "minimum": 207.0774, "maximum": 647.6524, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 259.44 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 571.25, "10th_percentile": 571.25, "90th_percentile": 571.25, "count": "1 through 10" } ] } ] }, { "description": "HEADACHES WITH MCC", "code_information": [ { "code": "102", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6501.0, "minimum": 6501.05, "maximum": 13214.27, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13214.27 } ] } ] }, { "description": "HC DECLOT THROMBOLYTIC AGENT IMPLANT DEV/CATH", "code_information": [ { "code": "36593", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1102.5, "discounted_cash": 319.0, "minimum": 319.725, "maximum": 999.9675, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 302.4, "10th_percentile": 302.4, "90th_percentile": 302.4, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 840.0, "10th_percentile": 840.0, "90th_percentile": 840.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 268.8, "10th_percentile": 268.8, "90th_percentile": 285.6, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 564.48, "10th_percentile": 282.24, "90th_percentile": 564.48, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 282.24, "10th_percentile": 282.24, "90th_percentile": 282.24, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 285.6, "10th_percentile": 285.6, "90th_percentile": 285.6, "count": "1 through 10" } ] } ] }, { "description": "HC TEMPOROMANDBLE JT ARTHROGRAPHY RS&I", "code_information": [ { "code": "70332", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1396.25, "discounted_cash": 404.0, "minimum": 227.36, "maximum": 1266.3988, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 231.93 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 284.2 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 227.36 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 284.2 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 284.2 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 485.01 } ] } ] }, { "description": "OTHER VASCULAR PROCEDURES WITH MCC", "code_information": [ { "code": "252", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11881.0, "minimum": 11881.22, "maximum": 41123.5, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 41123.5 } ] } ] }, { "description": "ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITHOUT MCC", "code_information": [ { "code": "279", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7846.0, "minimum": 7846.09, "maximum": 42515.78, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 42515.78 } ] } ] }, { "description": "Lidocaine Inj 1% w/ Epinephrine-1:100000", "drug_information": { "unit": 30.0, "type": "ML" }, "code_information": [ { "code": "00409317817", "type": "NDC" }, { "code": "J2004", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC", "code_information": [ { "code": "408", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17485.0, "minimum": 17485.57, "maximum": 42034.79, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 42034.79 } ] } ] }, { "description": "HC NUCLEAR ANTIGEN ANTIBODY", "code_information": [ { "code": "86235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 185.63, "discounted_cash": 53.0, "minimum": 17.93, "maximum": 181.35, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 678.91, "10th_percentile": 678.91, "90th_percentile": 678.91, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 148.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 181.35 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 145.08 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 181.35 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 181.35 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 166.22 }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 420.0, "10th_percentile": 270.75, "90th_percentile": 693.75, "count": "14" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 274.96, "10th_percentile": 274.96, "90th_percentile": 274.96, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 173.76, "10th_percentile": 173.76, "90th_percentile": 173.76, "count": "1 through 10" } ] } ] }, { "description": "SPLENIC PROCEDURES WITH CC", "code_information": [ { "code": "800", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8742.0, "minimum": 8742.79, "maximum": 33119.96, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 33119.96 } ] } ] }, { "description": "HC (SUP SHELL A6532) COMPRESSION STOCKING BK40-50", "code_information": [ { "code": "A6532", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 86.88, "maximum": 86.88, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 86.88, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Dopamine in Dextrose 5% Inj 3.2 MG/ML", "drug_information": { "unit": 250.0, "type": "ML" }, "code_information": [ { "code": "00409185812", "type": "NDC" }, { "code": "J1265", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2.2365, "maximum": 8.82, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.82 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.34 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2.67 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 3.34 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 3.34 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2.24 } ] } ] }, { "description": "HC ASSAY OF ZINC", "code_information": [ { "code": "84630", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 113.75, "discounted_cash": 32.0, "minimum": 11.39, "maximum": 113.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 65.16, "10th_percentile": 65.16, "90th_percentile": 65.16, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 94.01 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 113.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 92.16 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 113.75 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 113.75 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 72.9, "10th_percentile": 71.53, "90th_percentile": 72.9, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 105.59 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 91.0, "10th_percentile": 91.0, "90th_percentile": 91.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 29.12, "10th_percentile": 29.12, "90th_percentile": 92.96, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL A7048) VACUUM DRAIN BOTTLE/TUBE KIT", "code_information": [ { "code": "A7048", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 58.86, "maximum": 58.86, "payers_information": [ { "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" } ] } ] }, { "description": "HC ASSAY OF HOMOCYSTINE", "code_information": [ { "code": "83090", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 326.25, "discounted_cash": 94.0, "minimum": 17.92, "maximum": 295.9087, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 170.61 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 90.51, "10th_percentile": 90.51, "90th_percentile": 90.51, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 136.49 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 170.61 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 170.61 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 166.13 }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 261.0, "10th_percentile": 261.0, "90th_percentile": 261.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 83.52, "10th_percentile": 83.52, "90th_percentile": 83.52, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 83.52, "10th_percentile": 83.52, "90th_percentile": 83.52, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL Q4106) DERMAGRAFT", "code_information": [ { "code": "Q4106", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 141.561, "maximum": 485.78, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 485.78 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 211.12 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 168.89 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 211.12 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 211.12 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 141.56 } ] } ] }, { "description": "AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC", "code_information": [ { "code": "240", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16364.0, "minimum": 16364.7, "maximum": 33604.49, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 33604.49 } ] } ] }, { "description": "HC NM THYROID UPTAKE W/BLOOD FLOW SNGLE/MULT QUAN", "code_information": [ { "code": "78014", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1270.31, "discounted_cash": 368.0, "minimum": 368.3899, "maximum": 1270.31, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 938.05 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1149.44 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 919.55 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1149.44 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1149.44 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1270.31 } ] } ] }, { "description": "HC (SUP SHELL Q4188) AMNIOARMOR, PER SQUARE CENTIMETER", "code_information": [ { "code": "Q4188", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1302.74, "maximum": 1628.45, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1628.45 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1302.74 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1628.45 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1628.45 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1553.9 } ] } ] }, { "description": "HC ASSAY OF URINE PHOSPHORUS", "code_information": [ { "code": "84105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 98.44, "discounted_cash": 28.0, "minimum": 5.78, "maximum": 89.2851, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 42.74 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 52.37 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 41.89 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 52.37 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 52.37 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 53.58 }, { "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" } ] } ] }, { "description": "HC CYTOPATH C/V THIN LAYER REDO", "code_information": [ { "code": "88143", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 182.19, "discounted_cash": 52.0, "minimum": 23.04, "maximum": 182.19, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 167.22 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 182.19 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 163.92 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 182.19 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 182.19 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 182.19 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 23.04, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "WOUND DEBRIDEMENTS FOR INJURIES WITH MCC", "code_information": [ { "code": "901", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18830.0, "minimum": 18830.62, "maximum": 49473.63, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 49473.63 } ] } ] }, { "description": "HC (SUP SHELL A6240) HYDROCOLLD DRG FILLER PASTE", "code_information": [ { "code": "A6240", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 17.45, "maximum": 17.45, "payers_information": [ { "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" } ] } ] }, { "description": "HC ALPHA-1-ANTITRYPSIN, PHENO", "code_information": [ { "code": "82104", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 362.19, "discounted_cash": 105.0, "minimum": 14.46, "maximum": 328.5063, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 222.53, "10th_percentile": 222.53, "90th_percentile": 222.53, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 119.34 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 146.23 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 116.98 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 146.23 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 146.23 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 134.05 }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 289.75, "10th_percentile": 289.75, "90th_percentile": 289.75, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 265.41, "10th_percentile": 265.41, "90th_percentile": 265.41, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 92.72, "10th_percentile": 92.72, "90th_percentile": 92.72, "count": "1 through 10" } ] } ] }, { "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": "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" } ] } ] }, { "description": "HC F5 COAGULATION FACTOR V ANAL LEIDEN VARIANT", "code_information": [ { "code": "81241", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 400.94, "discounted_cash": 116.0, "minimum": 73.37, "maximum": 400.94, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 292.72 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 358.68 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 286.94 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 358.68 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 358.68 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 400.94 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 73.37, "additional_payer_notes": "100.00% 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": 16364.0, "minimum": 16364.7, "maximum": 45563.23, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 45563.23 } ] } ] }, { "description": "HC ASSAY OF TRIGLYCERIDES", "code_information": [ { "code": "84478", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 154.69, "discounted_cash": 44.0, "minimum": 5.74, "maximum": 140.3038, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 47.49 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 58.19 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 46.55 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 58.19 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 58.19 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 53.21 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 48.8, "10th_percentile": 46.5, "90th_percentile": 123.75, "count": "1 through 10" }, { "payer_name": "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 5.74, "10th_percentile": 5.74, "90th_percentile": 5.74, "count": "13" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 5.74, "10th_percentile": 5.74, "90th_percentile": 39.6, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 39.6, "10th_percentile": 39.6, "90th_percentile": 42.08, "count": "1 through 10" } ] } ] }, { "description": "HEART FAILURE AND SHOCK WITH CC", "code_information": [ { "code": "292", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6501.0, "minimum": 6501.05, "maximum": 12990.573, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 6501.05, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 8575.28, "10th_percentile": 8575.28, "90th_percentile": 8575.28, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10008.84 } ] } ] }, { "description": "HC EX FOR NONSPEECH DEVICE RX INIT HR", "code_information": [ { "code": "92605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 638.13, "discounted_cash": 185.0, "minimum": 95.0, "maximum": 578.7839, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "HC MRI, PELVIS, W/O CONTRAST", "code_information": [ { "code": "72195", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2691.88, "discounted_cash": 780.0, "minimum": 780.6452, "maximum": 2441.5352, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 1210.04, "10th_percentile": 1210.04, "90th_percentile": 1210.04, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1725.03 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1380.01 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1725.03 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1725.03 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1412.69 } ] } ] }, { "description": "HC PARVOVIRUS", "code_information": [ { "code": "86747", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 507.19, "discounted_cash": 147.0, "minimum": 15.03, "maximum": 460.0213, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 76.83 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 94.14 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 75.31 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 94.14 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 94.14 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 139.34 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 237.92, "10th_percentile": 237.92, "90th_percentile": 237.92, "count": "1 through 10" }, { "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" } ] } ] }, { "description": "HC TRICHINELLA ANTIBODY", "code_information": [ { "code": "86784", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 198.44, "discounted_cash": 57.0, "minimum": 12.56, "maximum": 179.9851, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 103.68 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 127.04 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 101.63 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 127.04 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 127.04 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 116.44 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.56, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL - G0103 - 30100312", "code_information": [ { "code": "G0103", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 231.25, "minimum": 19.31, "maximum": 209.7438, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 66.6, "10th_percentile": 66.6, "90th_percentile": 66.6, "count": "15" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 185.99 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 64.16, "10th_percentile": 64.16, "90th_percentile": 64.16, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 148.79 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 185.99 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 185.99 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 179.01 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 183.84, "10th_percentile": 41.78, "90th_percentile": 185.0, "count": "13" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 59.2, "10th_percentile": 59.2, "90th_percentile": 59.2, "count": "17" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 59.2, "10th_percentile": 59.2, "90th_percentile": 59.2, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 62.9, "10th_percentile": 59.2, "90th_percentile": 62.9, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 62.9, "10th_percentile": 59.2, "90th_percentile": 62.9, "count": "1 through 10" } ] } ] }, { "description": "HC CT UPPER EXTREMITY WO CONTRAST", "code_information": [ { "code": "73200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1879.38, "discounted_cash": 545.0, "minimum": 545.0202, "maximum": 1704.5977, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 866.36, "10th_percentile": 866.36, "90th_percentile": 866.36, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 461.7, "10th_percentile": 461.7, "90th_percentile": 461.7, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 963.52 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 444.77, "10th_percentile": 444.77, "90th_percentile": 444.77, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 770.82 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 963.52 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 963.52 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1003.82 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 410.4, "10th_percentile": 410.4, "90th_percentile": 410.4, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1210.0, "10th_percentile": 1210.0, "90th_percentile": 1282.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 387.2, "10th_percentile": 387.2, "90th_percentile": 411.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 1025.1, "10th_percentile": 1025.1, "90th_percentile": 1025.1, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 410.4, "10th_percentile": 410.4, "90th_percentile": 410.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 410.4, "10th_percentile": 410.4, "90th_percentile": 410.4, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 411.4, "10th_percentile": 411.4, "90th_percentile": 411.4, "count": "1 through 10" } ] } ] }, { "description": "HC MRI BRAIN COMBO", "code_information": [ { "code": "70553", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3143.44, "discounted_cash": 911.0, "minimum": 900.0, "maximum": 2851.1001, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 1800.56, "10th_percentile": 1800.56, "90th_percentile": 1800.56, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 905.31, "10th_percentile": 905.31, "90th_percentile": 905.31, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2668.87 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 872.12, "10th_percentile": 872.12, "90th_percentile": 872.12, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2135.09 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2668.87 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2668.87 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1863.89 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 884.72, "10th_percentile": 864.72, "90th_percentile": 2164.0, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 544.85, "10th_percentile": 544.85, "90th_percentile": 544.85, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 2514.75, "10th_percentile": 2514.75, "90th_percentile": 2514.75, "count": "15" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 804.72, "10th_percentile": 804.72, "90th_percentile": 855.02, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 804.72, "10th_percentile": 804.72, "90th_percentile": 804.72, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 804.72, "10th_percentile": 804.72, "90th_percentile": 855.02, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 804.72, "10th_percentile": 804.72, "90th_percentile": 855.02, "count": "1 through 10" } ] } ] }, { "description": "Diphenhydramine HCl Tab 50 MG", "drug_information": { "unit": 100.0, "type": "EA" }, "code_information": [ { "code": "00904205661", "type": "NDC" }, { "code": "Q0163", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 3.99, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC KRAS GENE", "code_information": [ { "code": "81275", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 847.19, "discounted_cash": 245.0, "minimum": 193.25, "maximum": 847.19, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 847.19 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 847.19 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 847.19 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 847.19 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 847.19 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 847.19 }, { "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" } ] } ] }, { "description": "HC (SUP SHELL A6197) ALGINATE DRSG >16 <=48 SQ IN - A6197 - RU272040", "code_information": [ { "code": "A6197", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 23.44, "maximum": 23.44, "payers_information": [ { "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" } ] } ] }, { "description": "PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "042", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5156.0, "minimum": 5156.0, "maximum": 20367.82, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20367.82 } ] } ] }, { "description": "CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION AND MCC", "code_information": [ { "code": "275", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18606.0, "minimum": 18606.44, "maximum": 84060.14, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 84060.14 } ] } ] }, { "description": "HC (SUP SHELL A5200) PERCUTANEOUS CATHETER ANCHOR", "code_information": [ { "code": "A5200", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 16.12, "maximum": 16.12, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.12, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC ANTIBIOTIC SENS,ENZYME DETECTION,EACH", "code_information": [ { "code": "87185", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 38.75, "discounted_cash": 11.0, "minimum": 4.75, "maximum": 38.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 38.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 38.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 38.4 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 38.75 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 38.75 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.75 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 29.25, "10th_percentile": 29.25, "90th_percentile": 31.0, "count": "1 through 10" } ] } ] }, { "description": "URINARY STONES WITH MCC", "code_information": [ { "code": "693", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8294.0, "minimum": 8294.44, "maximum": 15850.28, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15850.28 } ] } ] }, { "description": "FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY", "code_information": [ { "code": "934", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10984.0, "minimum": 10984.53, "maximum": 26060.72, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26060.72 } ] } ] }, { "description": "HC X-RAY JAW 4+ VW", "code_information": [ { "code": "70110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 660.63, "discounted_cash": 191.0, "minimum": 104.4, "maximum": 599.1914, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 106.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 130.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 104.4 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 130.5 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 130.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 270.71 } ] } ] }, { "description": "APPENDIX PROCEDURES WITH MCC", "code_information": [ { "code": "397", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10760.0, "minimum": 10760.35, "maximum": 28233.43, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28233.43 } ] } ] }, { "description": "HC (SUP SHELL A6196) ALGINATE DRESSING <=16 SQ IN", "code_information": [ { "code": "A6196", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 10.49, "maximum": 10.49, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 10.49, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "RESPIRATORY SIGNS AND SYMPTOMS", "code_information": [ { "code": "204", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4707.0, "minimum": 4707.65, "maximum": 9518.42, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9518.42 } ] } ] }, { "description": "Calcium Gluconate Inj 10%", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "63323036001", "type": "NDC" }, { "code": "J0612", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC BACTERIUM, ANTIBODY", "code_information": [ { "code": "86609", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 422.5, "discounted_cash": 122.0, "minimum": 12.88, "maximum": 383.2075, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 80.56 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 98.71 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 78.97 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 98.71 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 98.71 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 203.04, "10th_percentile": 203.04, "90th_percentile": 203.04, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 119.4 }, { "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" } ] } ] }, { "description": "OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC", "code_information": [ { "code": "832", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5828.0, "minimum": 5828.52, "maximum": 8506.93, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8506.93 } ] } ] }, { "description": "HC ASSAY OF INSULIN,TOTAL", "code_information": [ { "code": "83525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 228.44, "discounted_cash": 66.0, "minimum": 11.43, "maximum": 207.1951, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 115.61 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 92.49 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 115.61 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 115.61 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 105.96 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 182.75, "10th_percentile": 182.75, "90th_percentile": 182.75, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 167.4, "10th_percentile": 167.4, "90th_percentile": 167.4, "count": "1 through 10" } ] } ] }, { "description": "HC ARC RBC PRETREATMENT/CHEM OR DRUGS", "code_information": [ { "code": "86970", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 145.0, "discounted_cash": 42.0, "minimum": 42.05, "maximum": 145.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 145.0 } ] } ] }, { "description": "HC (SUP SHELL Q4257) RELESE, PER SQ CM", "code_information": [ { "code": "Q4257", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1559.061, "maximum": 2325.13, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2325.13 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1860.08 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2325.13 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2325.13 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1559.06 } ] } ] }, { "description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC", "code_information": [ { "code": "846", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13002.0, "minimum": 13002.09, "maximum": 30562.93, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30562.93 } ] } ] }, { "description": "OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITH CCMCC", "code_information": [ { "code": "729", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6949.0, "minimum": 6949.39, "maximum": 12480.99, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12480.99 } ] } ] }, { "description": "SKIN ULCERS WITH CC", "code_information": [ { "code": "593", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9415.0, "minimum": 9415.31, "maximum": 13985.27, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13985.27 } ] } ] }, { "description": "HC ASSAY TEST FOR BLOOD FECAL", "code_information": [ { "code": "82274", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 116.25, "discounted_cash": 33.0, "minimum": 15.92, "maximum": 116.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 33.48, "10th_percentile": 33.48, "90th_percentile": 33.48, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 115.1 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 116.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 32.25, "10th_percentile": 32.25, "90th_percentile": 32.25, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 112.83 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 116.25 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 116.25 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 73.1, "10th_percentile": 73.1, "90th_percentile": 73.1, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 116.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 15.92, "10th_percentile": 15.92, "90th_percentile": 15.92, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 93.0, "10th_percentile": 93.0, "90th_percentile": 93.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 15.92, "10th_percentile": 15.92, "90th_percentile": 29.76, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 29.76, "10th_percentile": 29.76, "90th_percentile": 29.76, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 31.62, "10th_percentile": 31.62, "90th_percentile": 31.62, "count": "1 through 10" } ] } ] }, { "description": "HC XRAY HIP W PELVIS, UNILAT 1 VW", "code_information": [ { "code": "73501", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 437.81, "discounted_cash": 126.0, "minimum": 126.9649, "maximum": 397.0937, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 203.03 } ] } ] }, { "description": "FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CCMCC", "code_information": [ { "code": "929", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13674.0, "minimum": 13674.61, "maximum": 37969.95, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 37969.95 } ] } ] }, { "description": "HC ASSAY OF PREGNENOLONE", "code_information": [ { "code": "84140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 106.88, "discounted_cash": 30.0, "minimum": 20.67, "maximum": 106.88, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 106.88 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 106.88 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 106.88 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 106.88 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 106.88 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 106.88 }, { "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" } ] } ] }, { "description": "HC MYCOPLASMA", "code_information": [ { "code": "86738", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 303.75, "discounted_cash": 88.0, "minimum": 13.24, "maximum": 275.5013, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 86.15 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 105.57 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 84.45 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 105.57 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 105.57 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 122.74 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L0631) LSO SAG R AN/POS PNL PRE CST", "code_information": [ { "code": "L0631", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1231.38, "maximum": 1231.38, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1231.38, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Prednisone Tab 5 MG", "drug_information": { "unit": 100.0, "type": "EA" }, "code_information": [ { "code": "64380078306", "type": "NDC" }, { "code": "J7512", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "TRANSURETHRAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "670", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4483.0, "minimum": 4483.48, "maximum": 11521.37, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11521.37 } ] } ] }, { "description": "HC HEP B CORE AB TEST, TOTAL", "code_information": [ { "code": "86704", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 144.06, "discounted_cash": 41.0, "minimum": 12.05, "maximum": 130.6624, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 84.28, "10th_percentile": 84.28, "90th_percentile": 88.51, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 99.49 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 121.92 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 37.72, "10th_percentile": 37.72, "90th_percentile": 37.72, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 97.53 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 121.92 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 121.92 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 89.18, "10th_percentile": 89.18, "90th_percentile": 89.18, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 90.59, "10th_percentile": 90.59, "90th_percentile": 90.59, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 111.71 }, { "payer_name": "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 115.25, "10th_percentile": 108.75, "90th_percentile": 115.25, "count": "46" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 34.8, "10th_percentile": 34.8, "90th_percentile": 34.8, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 99.62, "10th_percentile": 99.62, "90th_percentile": 104.53, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 36.88, "10th_percentile": 34.8, "90th_percentile": 36.88, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 36.88, "10th_percentile": 36.88, "90th_percentile": 36.88, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 36.88, "10th_percentile": 34.8, "90th_percentile": 36.98, "count": "1 through 10" } ] } ] }, { "description": "HC ORTHOTIC MGMT AND TRAIN INITIAL ENCTR EA 15 MIN", "code_information": [ { "code": "97760", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 139.06, "discounted_cash": 40.0, "minimum": 40.3274, "maximum": 126.1274, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 43.64, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CCMCC", "code_information": [ { "code": "096", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12553.0, "minimum": 12553.74, "maximum": 30406.14, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30406.14 } ] } ] }, { "description": "HC CLOSTRIDIUM AG, EIA", "code_information": [ { "code": "87324", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 270.31, "discounted_cash": 78.0, "minimum": 11.98, "maximum": 245.1712, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 94.58 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 115.89 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 92.71 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 115.89 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 115.89 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 111.06 }, { "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" } ] } ] }, { "description": "SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC", "code_information": [ { "code": "555", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8518.0, "minimum": 8518.61, "maximum": 15582.67, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15582.67 } ] } ] }, { "description": "OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC", "code_information": [ { "code": "270", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14122.0, "minimum": 14122.96, "maximum": 62202.2, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 62202.2 } ] } ] }, { "description": "Esmolol HCl Inj 100 MG/10ML", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "55150019410", "type": "NDC" }, { "code": "J1805", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.32, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.32 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.05 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.32 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.32 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC (SUP SHELL L2820) SOFT INTERFACE BELOW KNEE SE", "code_information": [ { "code": "L2820", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 132.53, "maximum": 132.53, "payers_information": [ { "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" } ] } ] }, { "description": "HC TUMOR IMAGING, WHOLE BODY, 2 OR MORE DAYS", "code_information": [ { "code": "78804", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2830.63, "discounted_cash": 820.0, "minimum": 820.8827, "maximum": 2830.63, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2021.92 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2477.56 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1982.03 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2477.56 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2477.56 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2830.63 } ] } ] }, { "description": "HC NM ACUTE GI BLOOD LOSS IMAGING", "code_information": [ { "code": "78278", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1004.38, "discounted_cash": 291.0, "minimum": 291.2702, "maximum": 1004.38, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 983.27 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1004.38 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 963.88 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1004.38 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1004.38 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1004.38 } ] } ] }, { "description": "CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CCMCC", "code_information": [ { "code": "788", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6501.0, "minimum": 6501.05, "maximum": 11303.27, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11303.27 } ] } ] }, { "description": "HC (SUP SHELL L3915) WHO NONTORSION JNTS PRE CST", "code_information": [ { "code": "L3915", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 580.28, "maximum": 580.28, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 580.28, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER DISORDERS OF THE EYE WITHOUT MCC", "code_information": [ { "code": "125", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4931.0, "minimum": 4931.83, "maximum": 9051.58, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9051.58 } ] } ] }, { "description": "Argatroban IV Soln 50 MG/50ML (1 MG/ML)", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "25021041450", "type": "NDC" }, { "code": "J0883", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2.9925, "maximum": 68.05, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 68.05 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.46 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3.57 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 4.46 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 4.46 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2.99 } ] } ] }, { "description": "HC ASSAY OF ALDOLASE", "code_information": [ { "code": "82085", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 118.13, "discounted_cash": 34.0, "minimum": 9.71, "maximum": 107.1439, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 72.58, "10th_percentile": 72.58, "90th_percentile": 72.58, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 80.1 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 98.16 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 78.52 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 98.16 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 98.16 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 90.02 }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 94.5, "10th_percentile": 94.5, "90th_percentile": 94.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 34.97, "10th_percentile": 34.97, "90th_percentile": 34.97, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL Q4046) CAST SUP SHT LEG SPLNT FBRGL", "code_information": [ { "code": "Q4046", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 23.79, "maximum": 23.79, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 23.79, "additional_payer_notes": "100.00% 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": 76.0, "minimum": 16.8, "maximum": 239.7927, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 151.43, "10th_percentile": 151.43, "90th_percentile": 163.91, "count": "38" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 76.14, "10th_percentile": 76.14, "90th_percentile": 76.14, "count": "90" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 138.67 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 169.92 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 73.35, "10th_percentile": 73.35, "90th_percentile": 73.35, "count": "101" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 135.94 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 169.92 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 169.92 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 134.73, "10th_percentile": 134.73, "90th_percentile": 134.73, "count": "42" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 166.24, "10th_percentile": 166.24, "90th_percentile": 169.43, "count": "75" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 155.74 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 211.5, "10th_percentile": 45.92, "90th_percentile": 211.5, "count": "133" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 49.16, "10th_percentile": 49.16, "90th_percentile": 49.16, "count": "1 through 10" }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 211.5, "10th_percentile": 211.5, "90th_percentile": 211.5, "count": "527" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 67.68, "10th_percentile": 67.68, "90th_percentile": 67.68, "count": "310" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 191.83, "10th_percentile": 169.05, "90th_percentile": 193.73, "count": "69" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 67.68, "10th_percentile": 67.68, "90th_percentile": 78.26, "count": "230" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 67.68, "10th_percentile": 67.68, "90th_percentile": 71.91, "count": "32" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 67.68, "10th_percentile": 67.68, "90th_percentile": 71.91, "count": "131" } ] } ] }, { "description": "HC PARATHYROID PLANAR IMAGING W/WO SUBTRACTION", "code_information": [ { "code": "78071", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1755.0, "discounted_cash": 508.0, "minimum": 508.95, "maximum": 1755.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1308.61 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1603.49 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1282.79 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1603.49 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1603.49 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1755.0 } ] } ] }, { "description": "HC COMPLETE CBC", "code_information": [ { "code": "85027", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 103.13, "discounted_cash": 29.0, "minimum": 6.47, "maximum": 93.5389, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 28.61, "10th_percentile": 26.97, "90th_percentile": 28.61, "count": "52" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 52.37 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 65.46 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 65.46 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 49.53, "10th_percentile": 49.53, "90th_percentile": 63.75, "count": "21" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 59.98 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 82.5, "10th_percentile": 5.32, "90th_percentile": 82.5, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 19.18, "10th_percentile": 17.81, "90th_percentile": 19.18, "count": "1 through 10" }, { "payer_name": "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 82.5, "10th_percentile": 77.75, "90th_percentile": 82.5, "count": "243" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 24.88, "10th_percentile": 6.47, "90th_percentile": 26.4, "count": "142" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 74.83, "10th_percentile": 24.88, "90th_percentile": 74.83, "count": "17" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 26.4, "10th_percentile": 24.88, "90th_percentile": 28.77, "count": "105" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 26.4, "10th_percentile": 24.88, "90th_percentile": 26.44, "count": "34" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 26.4, "10th_percentile": 24.88, "90th_percentile": 26.44, "count": "62" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 55.67, "10th_percentile": 55.67, "90th_percentile": 55.67, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 27.99, "10th_percentile": 27.99, "90th_percentile": 29.7, "count": "33" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 53.42 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 65.46 } ] } ] }, { "description": "GASTROINTESTINAL HEMORRHAGE WITHOUT CCMCC", "code_information": [ { "code": "379", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4483.0, "minimum": 4483.48, "maximum": 7431.77, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7431.77 } ] } ] }, { "description": "HC (SUP SHELL A4358) URINARY LEG OR ABDOMEN BAG - A4358 - 27100046", "code_information": [ { "code": "A4358", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 8.43, "maximum": 8.43, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.43, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC", "code_information": [ { "code": "699", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7173.0, "minimum": 7173.57, "maximum": 11965.81, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 7173.57, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 2143.82, "10th_percentile": 2143.82, "90th_percentile": 8575.28, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11965.81 } ] } ] }, { "description": "HC US, HEAD, REAL TIME", "code_information": [ { "code": "76506", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 641.56, "discounted_cash": 186.0, "minimum": 186.0524, "maximum": 641.56, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 252.4 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 309.28 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 247.42 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 309.28 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 309.28 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 641.56 } ] } ] }, { "description": "HC N.GONORRHOEAE, DNA, AMP PROB", "code_information": [ { "code": "87591", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 147.81, "discounted_cash": 42.0, "minimum": 35.09, "maximum": 147.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 79.83, "10th_percentile": 79.83, "90th_percentile": 90.82, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 42.57, "10th_percentile": 42.57, "90th_percentile": 42.57, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 147.81 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 147.81 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 147.81 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 147.81 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 147.81 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 71.03, "10th_percentile": 71.03, "90th_percentile": 75.33, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 92.94, "10th_percentile": 89.32, "90th_percentile": 92.94, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 147.81 }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 118.25, "10th_percentile": 111.5, "90th_percentile": 118.25, "count": "180" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 35.68, "10th_percentile": 35.68, "90th_percentile": 35.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 107.25, "10th_percentile": 102.13, "90th_percentile": 107.25, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 37.84, "10th_percentile": 37.84, "90th_percentile": 41.26, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 37.84, "10th_percentile": 37.84, "90th_percentile": 37.84, "count": "1 through 10" } ] } ] }, { "description": "DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CCMCC", "code_information": [ { "code": "443", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5380.0, "minimum": 5380.18, "maximum": 8248.75, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8248.75 } ] } ] }, { "description": "Omalizumab Subcutaneous Soln Auto-Injector 150 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "50242021555", "type": "NDC" }, { "code": "J2357", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 126.378, "maximum": 533.97, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 18206.35, "10th_percentile": 17413.05, "90th_percentile": 18206.35, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 533.97 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 188.48 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 150.78 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 188.48 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 188.48 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 126.38 } ] } ] }, { "description": "HC NUCLEAR THERAPY, MONOCLONAL AB", "code_information": [ { "code": "79403", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3777.81, "discounted_cash": 1095.0, "minimum": 407.57, "maximum": 3426.4737, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 415.78 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 509.47 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 407.57 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 509.47 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 509.47 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 854.4 } ] } ] }, { "description": "HC ANGIO EXTREMITY UNILAT", "code_information": [ { "code": "75710", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10259.7, "discounted_cash": 2975.0, "minimum": 583.6917, "maximum": 9305.5479, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 929.28 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1138.68 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 910.94 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1138.68 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1138.68 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 583.69 } ] } ] }, { "description": "HC (SUP SHELL A4605) TRACH SUCTION CATH CLOSE SYS", "code_information": [ { "code": "A4605", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 23.38, "maximum": 23.38, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 23.38, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF CITRATE", "code_information": [ { "code": "82507", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 561.25, "discounted_cash": 162.0, "minimum": 27.8, "maximum": 509.0537, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 229.52 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 281.24 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 224.99 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 281.24 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 281.24 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 257.72 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC CYP2C9 GENE ANALYSIS COMMON VARIANTS", "code_information": [ { "code": "81227", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 784.38, "discounted_cash": 227.0, "minimum": 174.81, "maximum": 784.38, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 547.79 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 671.23 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 536.98 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 671.23 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 671.23 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 784.38 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 174.81, "additional_payer_notes": "100.00% 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": 45.0, "minimum": 8.65, "maximum": 142.2902, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 84.85, "10th_percentile": 84.85, "90th_percentile": 91.84, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 42.66, "10th_percentile": 42.66, "90th_percentile": 45.18, "count": "12" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 71.34 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 87.42 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 41.1, "10th_percentile": 41.1, "90th_percentile": 82.19, "count": "29" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 69.93 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 87.42 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 87.42 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 75.48, "10th_percentile": 75.48, "90th_percentile": 150.97, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 93.14, "10th_percentile": 93.14, "90th_percentile": 189.86, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 80.19 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 82.16, "10th_percentile": 25.09, "90th_percentile": 118.5, "count": "24" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 29.17, "10th_percentile": 29.17, "90th_percentile": 29.17, "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 118.5, "10th_percentile": 118.5, "90th_percentile": 125.5, "count": "108" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 37.92, "10th_percentile": 8.65, "90th_percentile": 75.84, "count": "100" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 108.55, "10th_percentile": 107.48, "90th_percentile": 341.49, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 37.92, "10th_percentile": 37.92, "90th_percentile": 113.99, "count": "52" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 40.16, "10th_percentile": 37.92, "90th_percentile": 116.0, "count": "12" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 37.92, "10th_percentile": 37.92, "90th_percentile": 75.84, "count": "27" } ] } ] }, { "description": "Ampicillin Sodium For Inj 2 GM", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "55150011420", "type": "NDC" }, { "code": "J0290", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.89, "maximum": 16.45, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.45 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2.82 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2.25 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2.82 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2.82 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.89 } ] } ] }, { "description": "HC ONCOPROTEIN DCP", "code_information": [ { "code": "83951", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 298.13, "discounted_cash": 86.0, "minimum": 64.41, "maximum": 298.13, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 298.13 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 298.13 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 298.13 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 298.13 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 298.13 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 298.13 }, { "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" } ] } ] }, { "description": "HC (SUP SHELL L1902) AFO ANKLE GAUNTLET PRE OTS", "code_information": [ { "code": "L1902", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 105.66, "maximum": 105.66, "payers_information": [ { "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" } ] } ] }, { "description": "LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC", "code_information": [ { "code": "841", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8966.0, "minimum": 6888.2376, "maximum": 19232.54, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19232.54 } ] } ] }, { "description": "HC CYTOPATH,OTHR SOURC,PREP,SCRN,INTERP", "code_information": [ { "code": "88161", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 141.56, "discounted_cash": 41.0, "minimum": 41.0524, "maximum": 141.56, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 141.56 } ] } ] }, { "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": 116.0, "minimum": 116.4524, "maximum": 401.56, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 355.95 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 401.56 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 348.93 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 401.56 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 401.56 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 401.56 } ] } ] }, { "description": "HC CT SCAN HEAD COMBO", "code_information": [ { "code": "70470", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2818.13, "discounted_cash": 817.0, "minimum": 650.0, "maximum": 2556.0439, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1372.87 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1098.29 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1372.87 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1372.87 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1001.02 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 2254.5, "10th_percentile": 2254.5, "90th_percentile": 2254.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 721.44, "10th_percentile": 721.44, "90th_percentile": 721.44, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 680.64, "10th_percentile": 680.64, "90th_percentile": 723.18, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL L3901) HINGE EXT/FLEX WRIST FINGER", "code_information": [ { "code": "L3901", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1807.05, "maximum": 1807.05, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1807.05, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL L8691) AOI SND PROC REPL EXCL ACTUA", "code_information": [ { "code": "L8691", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2069.73, "maximum": 2069.73, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2069.73, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "FEVER AND INFLAMMATORY CONDITIONS", "code_information": [ { "code": "864", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5828.0, "minimum": 5828.52, "maximum": 10465.08, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10465.08 } ] } ] }, { "description": "HC ALPHA-1-ANTITRYPSIN, TOTAL", "code_information": [ { "code": "82103", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 203.13, "discounted_cash": 58.0, "minimum": 13.44, "maximum": 184.2389, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 124.8, "10th_percentile": 124.8, "90th_percentile": 124.8, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 110.86 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 135.84 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 108.67 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 135.84 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 135.84 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 127.73, "10th_percentile": 127.73, "90th_percentile": 130.18, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 124.6 }, { "payer_name": "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 162.5, "10th_percentile": 162.5, "90th_percentile": 162.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 148.85, "10th_percentile": 148.85, "90th_percentile": 148.85, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 52.0, "10th_percentile": 52.0, "90th_percentile": 52.0, "count": "1 through 10" } ] } ] }, { "description": "MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH CCMCC", "code_information": [ { "code": "507", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11432.0, "minimum": 11432.87, "maximum": 21295.61, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21295.61 } ] } ] }, { "description": "KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC", "code_information": [ { "code": "651", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12329.0, "minimum": 12329.57, "maximum": 43687.6, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 43687.6 } ] } ] }, { "description": "HC FUNGUS, ANTIBODY", "code_information": [ { "code": "86671", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 183.75, "discounted_cash": 53.0, "minimum": 12.25, "maximum": 166.6612, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 80.56 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 98.71 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 78.97 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 98.71 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 98.71 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 113.56 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "100.00% 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": 99.0, "minimum": 70.06, "maximum": 310.9287, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 71.47 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 87.58 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 70.06 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 87.58 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 87.58 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 224.89, "10th_percentile": 224.89, "90th_percentile": 224.89, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 180.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 87.76, "10th_percentile": 87.76, "90th_percentile": 87.76, "count": "1 through 10" } ] } ] }, { "description": "Olanzapine For IM Inj 10 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00517095501", "type": "NDC" }, { "code": "J2359", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2.9295, "maximum": 4.37, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.37 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3.5 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 4.37 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 4.37 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2.93 } ] } ] }, { "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": 197.0, "minimum": 197.1101, "maximum": 616.4788, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 184.68, "10th_percentile": 184.68, "90th_percentile": 195.75, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 348.22, "10th_percentile": 348.22, "90th_percentile": 348.22, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 397.6 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 354.64, "10th_percentile": 354.64, "90th_percentile": 354.64, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 543.75, "10th_percentile": 513.0, "90th_percentile": 543.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 174.0, "10th_percentile": 164.16, "90th_percentile": 174.42, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 434.62, "10th_percentile": 434.62, "90th_percentile": 493.18, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 174.0, "10th_percentile": 164.16, "90th_percentile": 174.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 164.16, "10th_percentile": 164.16, "90th_percentile": 164.16, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL A4402) LUBRICANT PER OUNCE", "code_information": [ { "code": "A4402", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2.27, "maximum": 2.27, "payers_information": [ { "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" } ] } ] }, { "description": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "836", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6501.0, "minimum": 6501.05, "maximum": 14376.66, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14376.66 } ] } ] }, { "description": "HC CT SCAN,LOWER EXTREMITY,W/O CONTRAST", "code_information": [ { "code": "73700", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2168.75, "discounted_cash": 628.0, "minimum": 628.9375, "maximum": 1967.0563, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 547.92, "10th_percentile": 545.58, "90th_percentile": 547.92, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 963.52 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 557.13, "10th_percentile": 527.83, "90th_percentile": 601.7, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 770.82 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 963.52 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 963.52 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 1150.18, "10th_percentile": 1150.18, "90th_percentile": 2033.86, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 727.51 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 487.04, "10th_percentile": 210.27, "90th_percentile": 1456.4, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1522.0, "10th_percentile": 1435.75, "90th_percentile": 1522.0, "count": "11" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 487.04, "10th_percentile": 459.44, "90th_percentile": 974.16, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 919.04, "10th_percentile": 919.04, "90th_percentile": 919.04, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 531.23, "10th_percentile": 514.08, "90th_percentile": 974.16, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 523.76, "10th_percentile": 487.04, "90th_percentile": 556.5, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 484.96, "10th_percentile": 484.96, "90th_percentile": 555.2, "count": "1 through 10" } ] } ] }, { "description": "PLEURAL EFFUSION WITH CC", "code_information": [ { "code": "187", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6725.0, "minimum": 6725.22, "maximum": 11660.48, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11660.48 } ] } ] }, { "description": "HC LYME DISEASE ANTIBODY, CONFIRMATORY", "code_information": [ { "code": "86617", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 139.38, "discounted_cash": 40.0, "minimum": 15.49, "maximum": 139.38, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 127.82 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 139.38 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 125.3 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 139.38 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 139.38 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 134.09, "10th_percentile": 134.09, "90th_percentile": 134.09, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 139.38 }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 223.0, "10th_percentile": 210.5, "90th_percentile": 223.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 71.36, "10th_percentile": 67.36, "90th_percentile": 71.57, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 71.36, "10th_percentile": 71.36, "90th_percentile": 71.36, "count": "1 through 10" } ] } ] }, { "description": "HC ASSAY OF OSTEOCALCIN", "code_information": [ { "code": "83937", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 450.94, "discounted_cash": 130.0, "minimum": 29.85, "maximum": 409.0026, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 246.42 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 301.95 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 241.56 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 301.95 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 301.95 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 276.72 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 29.85, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CONNECTIVE TISSUE DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "547", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5604.0, "minimum": 5604.35, "maximum": 9857.95, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9857.95 } ] } ] }, { "description": "Naltrexone For IM Extended Release Susp 380 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "65757030001", "type": "NDC" }, { "code": "J2315", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 12.978, "maximum": 47.92, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 47.92 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.35 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 15.48 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 19.35 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 19.35 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.98 } ] } ] }, { "description": "Tetanus Immune Globulin (Human) IM Soln Pref Syr 250 Unit/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "13533063402", "type": "NDC" }, { "code": "J1670", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1813.644, "maximum": 4592.09, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4592.09 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2704.81 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2163.82 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2704.81 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2704.81 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1813.64 } ] } ] }, { "description": "Prothrombin Complex Concentrate Human-lans For Inj 500 Unit", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "68982026101", "type": "NDC" }, { "code": "J7165", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 10.1115, "maximum": 15.08, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.08 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 12.06 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 15.08 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 15.08 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.11 } ] } ] }, { "description": "NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC", "code_information": [ { "code": "098", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13226.0, "minimum": 13226.27, "maximum": 27054.53, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27054.53 } ] } ] }, { "description": "HC X-RAY HYSTEROSALPINGOGRAM", "code_information": [ { "code": "74740", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1240.31, "discounted_cash": 359.0, "minimum": 228.83, "maximum": 1124.9612, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 233.43 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 286.03 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 228.83 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 286.03 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 286.03 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 640.1 } ] } ] }, { "description": "HC (SUP SHELL C1726) CATHETER BALLOON DILAT NON-VASCULAR", "code_information": [ { "code": "C1726", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 259.12, "10th_percentile": 259.12, "90th_percentile": 325.36, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 2730.57, "10th_percentile": 2730.57, "90th_percentile": 2730.57, "count": "1 through 10" } ] } ] }, { "description": "HC ANGIO VISCERAL SELECTV/SUBSELEC", "code_information": [ { "code": "75726", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9352.5, "discounted_cash": 2712.0, "minimum": 657.0373, "maximum": 8482.7175, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 917.63 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1124.41 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 899.52 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1124.41 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1124.41 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 657.04 } ] } ] }, { "description": "HC RADIOLOGIC EXAM ABDOMEN 1 VIEW", "code_information": [ { "code": "74018", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 402.19, "discounted_cash": 116.0, "minimum": 72.8, "maximum": 364.7863, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 115.83, "10th_percentile": 115.83, "90th_percentile": 115.83, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 74.26 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 91.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 111.59, "10th_percentile": 111.59, "90th_percentile": 111.59, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 72.8 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 91.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 91.0 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 204.95, "10th_percentile": 204.95, "90th_percentile": 257.72, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 243.13, "10th_percentile": 243.13, "90th_percentile": 243.13, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 183.3 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 102.96, "10th_percentile": 102.96, "90th_percentile": 102.96, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 321.75, "10th_percentile": 303.5, "90th_percentile": 321.75, "count": "27" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 102.96, "10th_percentile": 97.12, "90th_percentile": 102.96, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 278.01, "10th_percentile": 257.17, "90th_percentile": 291.83, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 97.12, "10th_percentile": 58.88, "90th_percentile": 102.96, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 97.12, "10th_percentile": 97.12, "90th_percentile": 102.96, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 102.96, "10th_percentile": 97.12, "90th_percentile": 103.19, "count": "1 through 10" } ] } ] }, { "description": "Human Papillomavirus (HPV) 9-Valent Recomb Vac IM Susp", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00006412102", "type": "NDC" }, { "code": "90649", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 514.206, "maximum": 2399.31, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2399.31 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 514.21 } ] } ] }, { "description": "HC (SUP SHELL Q4256) MLG COMPLET, PER SQ CM", "code_information": [ { "code": "Q4256", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2945.313, "maximum": 4392.54, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4392.54 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3513.99 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 4392.54 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 4392.54 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2945.31 } ] } ] }, { "description": "Heparin Sodium (Porcine) Inj 1000 Unit/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "25021040001", "type": "NDC" }, { "code": "J1644", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 2.95, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2.95 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.03 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.03 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.03 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES", "code_information": [ { "code": "003", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 51335.0, "minimum": 51335.85, "maximum": 250223.46, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 250223.46 } ] } ] }, { "description": "HC DECALCIFY TISSUE", "code_information": [ { "code": "88311", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 140.0, "discounted_cash": 40.0, "minimum": 40.6, "maximum": 126.98, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 99.57 }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 76.16, "10th_percentile": 76.16, "90th_percentile": 76.16, "count": "1 through 10" } ] } ] }, { "description": "HC ASSAY OF HALOPERIDOL", "code_information": [ { "code": "80173", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 602.19, "discounted_cash": 174.0, "minimum": 15.78, "maximum": 546.1863, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 120.18 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 147.27 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 117.81 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 147.27 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 147.27 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 146.29 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 110.53, "10th_percentile": 110.53, "90th_percentile": 110.53, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A6258) TRANSPARENT FILM >16<=48 IN", "code_information": [ { "code": "A6258", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 6.14, "maximum": 6.14, "payers_information": [ { "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" } ] } ] }, { "description": "HC TISSUE CULTURE, PLACENTA", "code_information": [ { "code": "88235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1107.5, "discounted_cash": 321.0, "minimum": 150.3, "maximum": 1107.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 725.52 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 889.01 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 711.21 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 889.01 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 889.01 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1107.5 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 150.3, "additional_payer_notes": "100.00% 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": 4931.0, "minimum": 4931.83, "maximum": 16101.39, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16101.39 } ] } ] }, { "description": "HC X-RAY TIB + FIB, 2VW", "code_information": [ { "code": "73590", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 493.44, "discounted_cash": 143.0, "minimum": 71.49, "maximum": 447.5501, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 266.71, "10th_percentile": 266.71, "90th_percentile": 266.71, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 142.11, "10th_percentile": 142.11, "90th_percentile": 142.11, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 72.93 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 89.36 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 129.18, "10th_percentile": 129.18, "90th_percentile": 136.9, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 71.49 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 89.36 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 89.36 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 251.46, "10th_percentile": 251.46, "90th_percentile": 305.45, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 310.27, "10th_percentile": 310.27, "90th_percentile": 310.27, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 203.03 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 126.32, "10th_percentile": 126.32, "90th_percentile": 126.32, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 372.5, "10th_percentile": 372.5, "90th_percentile": 394.75, "count": "26" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 126.32, "10th_percentile": 119.2, "90th_percentile": 126.65, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 341.21, "10th_percentile": 341.21, "90th_percentile": 358.04, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 126.32, "10th_percentile": 126.32, "90th_percentile": 126.32, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 119.2, "10th_percentile": 119.2, "90th_percentile": 126.65, "count": "1 through 10" } ] } ] }, { "description": "UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "738", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5156.0, "minimum": 5156.0, "maximum": 17312.12, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17312.12 } ] } ] }, { "description": "MINOR BLADDER PROCEDURES WITH CC", "code_information": [ { "code": "663", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8070.0, "minimum": 8070.26, "maximum": 17921.61, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17921.61 } ] } ] }, { "description": "HC (SUP SHELL A6457) TUBULAR DRESSING - A6457 - RU272066", "code_information": [ { "code": "A6457", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.62, "maximum": 1.62, "payers_information": [ { "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" } ] } ] }, { "description": "HC (SUP SHELL L3927) FO PIP DIP NO JT SPR PRE OTS", "code_information": [ { "code": "L3927", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 38.15, "maximum": 38.15, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 38.15, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HIV WITH OR WITHOUT OTHER RELATED CONDITION", "code_information": [ { "code": "977", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8070.0, "minimum": 8070.26, "maximum": 15298.56, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15298.56 } ] } ] }, { "description": "HC PROTEIN TOT XCPT REFRACTOMETRY OTH SRC", "code_information": [ { "code": "84157", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 101.25, "discounted_cash": 29.0, "minimum": 4.0, "maximum": 91.8337, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 30.24 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 37.06 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 28.09, "10th_percentile": 28.09, "90th_percentile": 28.09, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 29.65 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 37.06 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 37.06 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.08 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 25.92, "10th_percentile": 25.92, "90th_percentile": 25.92, "count": "1 through 10" } ] } ] }, { "description": "HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH", "code_information": [ { "code": "83521", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 118.13, "discounted_cash": 34.0, "minimum": 17.27, "maximum": 118.13, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 118.13 }, { "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" } ] } ] }, { "description": "HC X-RAY SACROILIAC JTS 3+ VW", "code_information": [ { "code": "72202", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 548.75, "discounted_cash": 159.0, "minimum": 98.69, "maximum": 497.7163, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 140.48, "10th_percentile": 140.48, "90th_percentile": 140.48, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 398.17, "10th_percentile": 398.17, "90th_percentile": 398.17, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 100.68 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 123.36 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 98.69 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 123.36 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 123.36 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 242.5 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 414.25, "10th_percentile": 414.25, "90th_percentile": 439.0, "count": "1 through 10" } ] } ] }, { "description": "NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "072", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5156.0, "minimum": 5156.0, "maximum": 8914.83, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8914.83 } ] } ] }, { "description": "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": 40.509, "maximum": 1133.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1133.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 60.41 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 48.33 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 60.41 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 60.41 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.51 } ] } ] }, { "description": "Romiplostim For Inj 250 MCG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "55513022101", "type": "NDC" }, { "code": "J2802", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 33.138, "maximum": 49.42, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 49.42 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 39.54 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 49.42 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 49.42 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.14 } ] } ] }, { "description": "Succinylcholine Chloride Inj 20 MG/ML", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "31722098110", "type": "NDC" }, { "code": "J0330", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2.646, "maximum": 28.79, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 95.48, "10th_percentile": 95.48, "90th_percentile": 95.48, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 28.79 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.95 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3.16 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 3.95 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 3.95 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2.65 } ] } ] }, { "description": "HC BRUCELLA, ANTIBODY", "code_information": [ { "code": "86622", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 122.5, "discounted_cash": 35.0, "minimum": 8.93, "maximum": 111.1075, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 71.74 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 87.9 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 70.32 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 87.9 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 87.9 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 82.79 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC DRUG SCREEN PRSMV QUAL DIR OPTICAL OBS PER DAY", "code_information": [ { "code": "80305", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 174.38, "discounted_cash": 50.0, "minimum": 12.6, "maximum": 158.1627, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 67.95 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 83.26 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 66.61 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 83.26 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 83.26 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 116.81 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "257", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6949.0, "minimum": 6949.39, "maximum": 12875.92, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12875.92 } ] } ] }, { "description": "HC MTHFR GENE", "code_information": [ { "code": "81291", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 513.44, "discounted_cash": 148.0, "minimum": 65.34, "maximum": 513.44, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 260.83 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 319.61 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 255.69 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 319.61 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 319.61 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 513.44 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 65.34, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC TETANUS ANTIBODY", "code_information": [ { "code": "86774", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 215.94, "discounted_cash": 62.0, "minimum": 14.8, "maximum": 195.8576, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 76.83 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 94.14 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 75.31 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 94.14 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 94.14 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 137.2 }, { "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" } ] } ] }, { "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": 193.0, "minimum": 93.082, "maximum": 606.5562, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 454.06 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 363.24 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 454.06 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 454.06 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 93.08 } ] } ] }, { "description": "HC (SUP SHELL L1845) KO DOUBLE UPRIGHT PRE CST", "code_information": [ { "code": "L1845", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1000.77, "maximum": 1000.77, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1000.77, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC ANGIO EA ADDNL SELECTV VESSEL", "code_information": [ { "code": "75774", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3070.0, "discounted_cash": 890.0, "minimum": 431.4006, "maximum": 2784.49, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 808.21 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 990.34 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 792.27 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 990.34 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 990.34 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 431.4 } ] } ] }, { "description": "HC CT UPPER EXTREMITY WO/W CONTRAST", "code_information": [ { "code": "73202", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2008.13, "discounted_cash": 582.0, "minimum": 582.3577, "maximum": 1821.3739, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1691.07 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1352.85 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1691.07 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1691.07 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1680.6 } ] } ] }, { "description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "517", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5156.0, "minimum": 5156.0, "maximum": 18116.13, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18116.13 } ] } ] }, { "description": "HC (SUP SHELL Q4174) PALINGEN OR PROMATRX", "code_information": [ { "code": "Q4174", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 917.5005, "maximum": 20014.31, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 20014.31 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1368.33 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1094.65 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1368.33 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1368.33 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 917.5 } ] } ] }, { "description": "HC ASSAY PHOSPHATASE ACID PROSTATIC", "code_information": [ { "code": "84066", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 270.31, "discounted_cash": 78.0, "minimum": 9.66, "maximum": 245.1712, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 79.71 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 97.67 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 78.14 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 97.67 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 97.67 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 89.55 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC", "code_information": [ { "code": "059", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8070.0, "minimum": 8070.26, "maximum": 14628.95, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14628.95 } ] } ] }, { "description": "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC", "code_information": [ { "code": "146", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12329.0, "minimum": 12329.57, "maximum": 24961.99, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24961.99 } ] } ] }, { "description": "CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES", "code_information": [ { "code": "018", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 27797.0, "minimum": 27797.58, "maximum": 509081.17, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 509081.17 } ] } ] }, { "description": "HC (SUP SHELL Q4176) NEOPATCH OR THERION, 1 SQ CM", "code_information": [ { "code": "Q4176", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 207.648, "maximum": 309.68, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 309.68 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 247.74 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 309.68 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 309.68 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 207.65 } ] } ] }, { "description": "HC NM PULMONARY VENTILATION & PERFUSION IMAGING", "code_information": [ { "code": "78582", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1826.56, "discounted_cash": 529.0, "minimum": 529.7024, "maximum": 1826.56, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1100.05 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1347.94 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1078.35 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1347.94 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1347.94 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1826.56 } ] } ] }, { "description": "HC SURG PATH,LEVEL V", "code_information": [ { "code": "88307", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 774.06, "discounted_cash": 224.0, "minimum": 224.4774, "maximum": 774.06, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 774.06 } ] } ] }, { "description": "HC (SUP SHELL Q4021) CAST SUP SHT ARM SPLINT PLST", "code_information": [ { "code": "Q4021", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 8.59, "maximum": 8.59, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.59, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITHOUT CCMCC", "code_information": [ { "code": "494", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6276.0, "minimum": 6276.87, "maximum": 23654.59, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23654.59 } ] } ] }, { "description": "FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CCMCC", "code_information": [ { "code": "928", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 27797.0, "minimum": 27797.58, "maximum": 84558.82, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 84558.82 } ] } ] }, { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "440", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4931.0, "minimum": 4931.83, "maximum": 7325.67, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "other", "standard_charge_dollar": 5153.76, "standard_charge_algorithm": "2342.62 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 7087.5, "10th_percentile": 7087.5, "90th_percentile": 7087.5, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7325.67 } ] } ] }, { "description": "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, "discounted_cash": 116.0, "minimum": 116.0, "maximum": 400.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 400.0 } ] } ] }, { "description": "OTHER VASCULAR PROCEDURES WITH CC", "code_information": [ { "code": "253", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8294.0, "minimum": 8294.44, "maximum": 30599.48, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30599.48 } ] } ] }, { "description": "HC ENZYME CELL ACTIVITY", "code_information": [ { "code": "82657", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 380.63, "discounted_cash": 110.0, "minimum": 22.17, "maximum": 345.2314, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 149.07 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 182.66 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 146.13 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 182.66 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 182.66 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 205.53 }, { "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" } ] } ] }, { "description": "HC NM BONE IMAGING, LIMITED AREA", "code_information": [ { "code": "78300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 652.19, "discounted_cash": 189.0, "minimum": 189.1351, "maximum": 652.19, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 544.16 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 652.19 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 533.42 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 652.19 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 652.19 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 652.19 } ] } ] }, { "description": "Levofloxacin in D5W IV Soln 250 MG/50ML", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "44567043524", "type": "NDC" }, { "code": "J1956", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 3.2445, "maximum": 18.36, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.36 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.79 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3.83 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 4.79 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 4.79 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.24 } ] } ] }, { "description": "MAJOR ESOPHAGEAL DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "370", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4707.0, "minimum": 4707.65, "maximum": 8261.72, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8261.72 } ] } ] }, { "description": "HC OBSERVATION PER HOUR", "code_information": [ { "code": "G0378", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 141.29, "minimum": 40.9741, "maximum": 128.15, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 1790.4, "10th_percentile": 1261.41, "90th_percentile": 2848.36, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 1332.76, "10th_percentile": 235.19, "90th_percentile": 2590.6, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 1070.24, "10th_percentile": 1070.24, "90th_percentile": 1070.24, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1130.25, "10th_percentile": 308.25, "90th_percentile": 2260.5, "count": "37" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 759.56, "10th_percentile": 289.36, "90th_percentile": 2367.36, "count": "12" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 375.0, "10th_percentile": 230.16, "90th_percentile": 1644.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 361.7, "10th_percentile": 217.02, "90th_percentile": 868.07, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 2061.67, "10th_percentile": 2061.67, "90th_percentile": 2061.67, "count": "1 through 10" } ] } ] }, { "description": "HC FRESH FROZEN PLASMA 24 PRODUCT", "code_information": [ { "code": "P9059", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 336.25, "minimum": 97.5125, "maximum": 304.9787, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 538.0, "10th_percentile": 538.0, "90th_percentile": 538.0, "count": "1 through 10" } ] } ] }, { "description": "REVISION OF HIP OR KNEE REPLACEMENT WITH CC", "code_information": [ { "code": "467", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6949.0, "minimum": 6949.39, "maximum": 41575.02, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 41575.02 } ] } ] }, { "description": "HC ASSAY OF VITAMIN B-1", "code_information": [ { "code": "84425", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 351.88, "discounted_cash": 102.0, "minimum": 21.23, "maximum": 319.1552, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 0.35, "10th_percentile": 0.35, "90th_percentile": 201.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 101.34, "10th_percentile": 101.34, "90th_percentile": 101.34, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 175.3 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 214.81 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 97.62, "10th_percentile": 97.62, "90th_percentile": 97.62, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 171.85 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 214.81 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 214.81 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 179.32, "10th_percentile": 179.32, "90th_percentile": 179.32, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 225.51, "10th_percentile": 225.51, "90th_percentile": 225.51, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 196.81 }, { "payer_name": "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 281.5, "10th_percentile": 281.5, "90th_percentile": 281.5, "count": "22" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 90.08, "10th_percentile": 90.08, "90th_percentile": 90.08, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 257.85, "10th_percentile": 257.85, "90th_percentile": 257.85, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 90.08, "10th_percentile": 90.08, "90th_percentile": 90.08, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 90.08, "10th_percentile": 90.08, "90th_percentile": 95.71, "count": "1 through 10" } ] } ] }, { "description": "CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC", "code_information": [ { "code": "414", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16364.0, "minimum": 16364.7, "maximum": 41999.42, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 41999.42 } ] } ] }, { "description": "DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC", "code_information": [ { "code": "442", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7173.0, "minimum": 7173.57, "maximum": 33127.914, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 7173.57, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 42640.42, "10th_percentile": 42640.42, "90th_percentile": 42640.42, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11379.9 } ] } ] }, { "description": "OTHER DISORDERS OF NERVOUS SYSTEM WITH CC", "code_information": [ { "code": "092", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6725.0, "minimum": 6725.22, "maximum": 17675.7633, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "other", "standard_charge_dollar": 6725.22, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 3899.84, "10th_percentile": 3899.84, "90th_percentile": 3899.84, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 6725.22, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 12862.92, "10th_percentile": 11699.52, "90th_percentile": 48748.0, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12060.13 } ] } ] }, { "description": "Palonosetron HCl IV Soln 0.25 MG/5ML (Base Equivalent)", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "60505619301", "type": "NDC" }, { "code": "J2469", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.575, "maximum": 332.16, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 332.16 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2.35 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.88 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2.35 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2.35 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.58 } ] } ] }, { "description": "HC XRAY HIPS W PELVIS, BILAT 3-4 VW", "code_information": [ { "code": "73522", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 714.06, "discounted_cash": 207.0, "minimum": 207.0774, "maximum": 647.6524, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 338.39 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 571.25, "10th_percentile": 571.25, "90th_percentile": 571.25, "count": "1 through 10" } ] } ] }, { "description": "HC CT SCAN ABDOMEN/PELVIS WO CONTRAST", "code_information": [ { "code": "74176", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2415.63, "discounted_cash": 700.0, "minimum": 554.88, "maximum": 2190.9764, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 562.79, "10th_percentile": 497.2, "90th_percentile": 1138.92, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1553.75, "10th_percentile": 1465.75, "90th_percentile": 1754.5, "count": "62" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 529.68, "10th_percentile": 469.04, "90th_percentile": 561.44, "count": "17" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 1409.25, "10th_percentile": 1409.25, "90th_percentile": 1516.21, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 497.2, "10th_percentile": 497.2, "90th_percentile": 612.44, "count": "21" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 561.44, "10th_percentile": 497.2, "90th_percentile": 562.79, "count": "16" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 529.68, "10th_percentile": 469.04, "90th_percentile": 561.44, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 1135.96, "10th_percentile": 1135.96, "90th_percentile": 1347.46, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 631.62, "10th_percentile": 527.67, "90th_percentile": 631.62, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 693.6 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 538.85, "10th_percentile": 508.33, "90th_percentile": 608.46, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 554.88 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 693.6 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 693.6 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 1221.25, "10th_percentile": 1221.25, "90th_percentile": 1221.25, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 899.54 } ] } ] }, { "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": 168.0, "minimum": 107.26, "maximum": 526.9126, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 109.41 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 134.07 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 107.26 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 134.07 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 134.07 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 245.3 } ] } ] }, { "description": "HC ST EVAL SPEECH SOUND PRODUCTION ARTICULATE, 15 MIN", "code_information": [ { "code": "92522", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 433.75, "discounted_cash": 125.0, "minimum": 95.0, "maximum": 393.4112, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 107.67, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC", "code_information": [ { "code": "580", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9191.0, "minimum": 9191.13, "maximum": 20371.36, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20371.36 } ] } ] }, { "description": "HC ASSAY OF FREE THYROXINE", "code_information": [ { "code": "84439", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 252.5, "discounted_cash": 73.0, "minimum": 9.02, "maximum": 229.0175, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 144.63, "10th_percentile": 144.63, "90th_percentile": 155.14, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 72.72, "10th_percentile": 72.72, "90th_percentile": 72.72, "count": "34" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 74.45 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 91.23 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 70.05, "10th_percentile": 70.05, "90th_percentile": 70.05, "count": "21" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 72.98 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 91.23 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 91.23 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 128.67, "10th_percentile": 128.67, "90th_percentile": 165.64, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 158.77, "10th_percentile": 158.77, "90th_percentile": 161.82, "count": "22" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 83.62 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 65.3, "10th_percentile": 21.22, "90th_percentile": 202.0, "count": "16" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 202.0, "10th_percentile": 202.0, "90th_percentile": 202.0, "count": "131" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 64.64, "10th_percentile": 64.64, "90th_percentile": 68.68, "count": "78" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 183.21, "10th_percentile": 183.21, "90th_percentile": 185.03, "count": "18" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 64.64, "10th_percentile": 64.64, "90th_percentile": 64.64, "count": "56" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 64.64, "10th_percentile": 64.64, "90th_percentile": 68.68, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 64.64, "10th_percentile": 64.64, "90th_percentile": 68.68, "count": "34" } ] } ] }, { "description": "HC RENAL FUNCTION STUDY", "code_information": [ { "code": "78725", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 885.63, "discounted_cash": 256.0, "minimum": 256.8327, "maximum": 803.2664, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 320.96 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 393.29 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 314.63 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 393.29 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 393.29 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 676.77 } ] } ] }, { "description": "HC MICRODISSECTION, MANUAL", "code_information": [ { "code": "88381", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 707.5, "discounted_cash": 205.0, "minimum": 205.175, "maximum": 707.5, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 707.5 } ] } ] }, { "description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC", "code_information": [ { "code": "478", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12105.0, "minimum": 12105.4, "maximum": 28991.46, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28991.46 } ] } ] }, { "description": "HC RANGE OF MOTION MEASUREMENTS - 95852 - 42000050", "code_information": [ { "code": "95852", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 71.88, "discounted_cash": 20.0, "minimum": 4.8, "maximum": 71.88, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 71.88 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY HEEL", "code_information": [ { "code": "73650", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 465.0, "discounted_cash": 134.0, "minimum": 71.49, "maximum": 421.755, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 72.93 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 89.36 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 71.49 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 89.36 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 89.36 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 177.63 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 372.0, "10th_percentile": 372.0, "90th_percentile": 372.0, "count": "1 through 10" } ] } ] }, { "description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "310", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4035.0, "minimum": 3907.0815, "maximum": 6673.74, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6673.74 } ] } ] }, { "description": "HC (SUP SHELL A6456) ZINC PASTE BAND W >=3<5/YD - A6456 - RU272008", "code_information": [ { "code": "A6456", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.79, "maximum": 1.79, "payers_information": [ { "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" } ] } ] }, { "description": "HC MICROSLIDE CONSULT", "code_information": [ { "code": "88321", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1369.06, "discounted_cash": 397.0, "minimum": 397.0274, "maximum": 1241.7374, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1106.25 } ] } ] }, { "description": "HC (SUP SHELL L8658) INTERPHALANGEAL JOINT SPACER", "code_information": [ { "code": "L8658", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 498.19, "maximum": 498.19, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 498.19, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC ANTISTREPTOLYSIN O SCREEN", "code_information": [ { "code": "86063", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 115.0, "discounted_cash": 33.0, "minimum": 5.77, "maximum": 104.305, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 47.71 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 58.46 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 46.77 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 58.46 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 58.46 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 53.49 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC GLUCOSE BLOOD TEST", "code_information": [ { "code": "82962", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 37.5, "discounted_cash": 10.0, "minimum": 3.28, "maximum": 34.0125, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 19.33 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.69 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 18.95 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 23.69 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 23.69 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.41 }, { "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" } ] } ] }, { "description": "OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CCMCC", "code_information": [ { "code": "804", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3810.0, "minimum": 3810.96, "maximum": 15985.86, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15985.86 } ] } ] }, { "description": "Hydroxyzine HCl Tab 25 MG", "drug_information": { "unit": 100.0, "type": "EA" }, "code_information": [ { "code": "23155050101", "type": "NDC" }, { "code": "Q0177", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 3.68, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.68 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC HEP B CORE AB TEST, IGM", "code_information": [ { "code": "86705", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 144.06, "discounted_cash": 41.0, "minimum": 11.77, "maximum": 130.6624, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 77.87, "10th_percentile": 77.87, "90th_percentile": 77.87, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 97.12 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 119.01 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 95.2 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 119.01 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 119.01 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 73.41, "10th_percentile": 73.41, "90th_percentile": 73.41, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 87.12, "10th_percentile": 87.12, "90th_percentile": 87.12, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 109.11 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 108.75, "10th_percentile": 108.75, "90th_percentile": 115.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 34.8, "10th_percentile": 34.8, "90th_percentile": 34.8, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 34.8, "10th_percentile": 34.8, "90th_percentile": 34.8, "count": "1 through 10" } ] } ] }, { "description": "SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CCMCC", "code_information": [ { "code": "578", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5156.0, "minimum": 5156.0, "maximum": 18937.82, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18937.82 } ] } ] }, { "description": "HC MRI BRAIN", "code_information": [ { "code": "70551", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2178.75, "discounted_cash": 631.0, "minimum": 631.8375, "maximum": 1976.1263, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 1247.99, "10th_percentile": 1247.99, "90th_percentile": 1338.62, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 313.74, "10th_percentile": 313.74, "90th_percentile": 627.48, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1726.81 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 604.47, "10th_percentile": 604.47, "90th_percentile": 604.47, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1381.44 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1726.81 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1726.81 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 1396.32, "10th_percentile": 1396.32, "90th_percentile": 1396.32, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1119.44 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 205.2, "10th_percentile": 60.0, "90th_percentile": 557.76, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1743.0, "10th_percentile": 1743.0, "90th_percentile": 1743.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 557.76, "10th_percentile": 557.76, "90th_percentile": 592.62, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 557.76, "10th_percentile": 557.76, "90th_percentile": 557.76, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 557.76, "10th_percentile": 557.76, "90th_percentile": 592.62, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 557.76, "10th_percentile": 557.76, "90th_percentile": 592.62, "count": "1 through 10" } ] } ] }, { "description": "HC HEART FIRST PASS ADD-ON", "code_information": [ { "code": "78496", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1081.56, "discounted_cash": 313.0, "minimum": 160.7594, "maximum": 980.9749, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 370.55 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 454.06 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 363.24 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 454.06 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 454.06 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.76 } ] } ] }, { "description": "AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC", "code_information": [ { "code": "239", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24883.0, "minimum": 24883.31, "maximum": 58021.82, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 58021.82 } ] } ] }, { "description": "HC ASSAY OF TOTAL THYROXINE", "code_information": [ { "code": "84436", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 134.06, "discounted_cash": 38.0, "minimum": 6.87, "maximum": 121.5924, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 82.37, "10th_percentile": 82.37, "90th_percentile": 83.12, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 56.7 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 69.48 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 37.2, "10th_percentile": 37.2, "90th_percentile": 37.2, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 55.58 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 69.48 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 69.48 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 63.69 }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 107.25, "10th_percentile": 107.25, "90th_percentile": 107.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 34.32, "10th_percentile": 6.87, "90th_percentile": 34.32, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 34.32, "10th_percentile": 34.32, "90th_percentile": 34.32, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 34.32, "10th_percentile": 34.32, "90th_percentile": 34.32, "count": "1 through 10" } ] } ] }, { "description": "HC MORPH INSITU HYBRIDIZE MANL PER SPCMN, INIT SING PROB STAIN", "code_information": [ { "code": "88368", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1868.13, "discounted_cash": 541.0, "minimum": 541.7577, "maximum": 1694.3939, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1232.51 } ] } ] }, { "description": "HC CALCULUS ASSAY,INFRARED SPECTR", "code_information": [ { "code": "82365", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 311.88, "discounted_cash": 90.0, "minimum": 12.9, "maximum": 282.8752, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 106.45 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 130.44 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 104.35 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 130.44 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 130.44 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 119.59 }, { "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": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 180.0, "10th_percentile": 180.0, "90th_percentile": 180.0, "count": "1 through 10" } ] } ] }, { "description": "HC ARC BLOOD TYPING, RH PHENOTYPE", "code_information": [ { "code": "86906", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 674.69, "discounted_cash": 195.0, "minimum": 62.68, "maximum": 611.9438, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 63.94 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 78.34 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 62.68 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 78.34 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 78.34 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 71.85 } ] } ] }, { "description": "HC ASSAY BLOOD CARBON DIOXIDE", "code_information": [ { "code": "82374", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 47.19, "discounted_cash": 13.0, "minimum": 4.88, "maximum": 47.19, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 40.36 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 47.19 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 39.57 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 47.19 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 47.19 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 45.24 }, { "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": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 12.08, "10th_percentile": 12.08, "90th_percentile": 12.08, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL A6450) LT COMPRES BAND >=5/YD - A6450 - 27090040", "code_information": [ { "code": "A6450", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2.5, "maximum": 2.5, "payers_information": [ { "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" } ] } ] }, { "description": "Haloperidol Lactate Inj 5 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "63323047400", "type": "NDC" }, { "code": "J1630", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2.457, "maximum": 14.57, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.57 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.66 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2.93 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 3.66 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 3.66 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2.46 } ] } ] }, { "description": "HC (SUP SHELL A6402) STERILE GAUZE <= 16 SQ IN - A6402 - RU272059", "code_information": [ { "code": "A6402", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "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" } ] } ] }, { "description": "SIGNS AND SYMPTOMS WITH MCC", "code_information": [ { "code": "947", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8294.0, "minimum": 8294.44, "maximum": 40389.8616, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "other", "standard_charge_dollar": 8294.44, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 4058.34, "10th_percentile": 4058.34, "90th_percentile": 9749.6, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "other", "standard_charge_dollar": 8667.69, "standard_charge_algorithm": "2342.62 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 7801.74, "10th_percentile": 7218.72, "90th_percentile": 28270.99, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 8294.44, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 13649.44, "10th_percentile": 11699.52, "90th_percentile": 31198.72, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "other", "standard_charge_dollar": 8294.44, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 77555.02, "10th_percentile": 77555.02, "90th_percentile": 77555.02, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14964.93 } ] } ] }, { "description": "RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CCMCC", "code_information": [ { "code": "179", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5380.0, "minimum": 5380.18, "maximum": 8900.68, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8900.68 } ] } ] }, { "description": "VAGINAL DELIVERY WITH STERILIZATION ANDOR D&C WITHOUT CCMCC", "code_information": [ { "code": "798", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5156.0, "minimum": 5156.0, "maximum": 11283.23, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11283.23 } ] } ] }, { "description": "HC TRG GENE REARRANGEMENT ANAL", "code_information": [ { "code": "81342", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1025.0, "discounted_cash": 297.0, "minimum": 201.5, "maximum": 1025.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 314.71 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 385.63 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 308.5 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 385.63 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 385.63 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1025.0 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 201.5, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC MR SAFETY IMPLT ELECTRONICS PREPJ SUPVJ PHYS/QHP", "code_information": [ { "code": "76018", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 344.38, "discounted_cash": 99.0, "minimum": 99.8702, "maximum": 344.38, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 344.38 } ] } ] }, { "description": "HC (SUP SHELL A4344) CATH INDW FOLEY 2 WAY SILICN - A4344 - 27200065", "code_information": [ { "code": "A4344", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 22.81, "maximum": 22.81, "payers_information": [ { "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" } ] } ] }, { "description": "HC (SUP SHELL A4310) INSERT TRAY W/O BAG/CATH", "code_information": [ { "code": "A4310", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 11.01, "maximum": 11.01, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.01, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Heparin Sodium (Porcine) Inj 5000 Unit/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00409272330", "type": "NDC" }, { "code": "J1644", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 2.95, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2.95 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.03 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.03 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.03 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "OTITIS MEDIA AND URI WITHOUT MCC", "code_information": [ { "code": "153", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4931.0, "minimum": 4931.83, "maximum": 8702.63, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8702.63 } ] } ] }, { "description": "HC (SUP SHELL Q4101) APLIGRAF PER SQ CM", "code_information": [ { "code": "Q4101", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 95.634, "maximum": 452.7, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 452.7 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 142.63 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 114.1 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 142.63 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 142.63 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.63 } ] } ] }, { "description": "TENDONITIS, MYOSITIS AND BURSITIS WITH MCC", "code_information": [ { "code": "557", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10536.0, "minimum": 10536.18, "maximum": 17529.03, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17529.03 } ] } ] }, { "description": "Ceftriaxone Sodium For Inj 2 GM", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "60505614900", "type": "NDC" }, { "code": "J0696", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.5435, "maximum": 8.66, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 12.77, "10th_percentile": 12.77, "90th_percentile": 12.77, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.66 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2.3 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.84 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2.3 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2.3 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.54 } ] } ] }, { "description": "HC (SUP SHELL C1889) IMPLANT/INSERT DEVICE, NOC - C1889 - 27201889", "code_information": [ { "code": "C1889", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 135.04, "10th_percentile": 135.04, "90th_percentile": 135.04, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 697.41, "10th_percentile": 697.41, "90th_percentile": 697.41, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 121.9, "10th_percentile": 121.9, "90th_percentile": 121.9, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1143.25, "10th_percentile": 1143.25, "90th_percentile": 1143.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 365.84, "10th_percentile": 341.92, "90th_percentile": 731.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 4552.59, "10th_percentile": 4246.27, "90th_percentile": 6003.22, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 59.25, "10th_percentile": 59.25, "90th_percentile": 365.84, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 59.25, "10th_percentile": 59.25, "90th_percentile": 59.25, "count": "1 through 10" } ] } ] }, { "description": "MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC", "code_information": [ { "code": "641", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5828.0, "minimum": 5828.52, "maximum": 11007.561, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "other", "standard_charge_dollar": 5828.52, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 7799.68, "10th_percentile": 7799.68, "90th_percentile": 13649.44, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 5828.52, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 4287.64, "10th_percentile": 4287.64, "90th_percentile": 6431.46, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "other", "standard_charge_dollar": 5828.52, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 12300.0, "10th_percentile": 12300.0, "90th_percentile": 12300.0, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "other", "standard_charge_dollar": 5828.52, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 9689.89, "10th_percentile": 9689.89, "90th_percentile": 9689.89, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9174.18 } ] } ] }, { "description": "PROSTATECTOMY WITH CC", "code_information": [ { "code": "666", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8070.0, "minimum": 8070.26, "maximum": 20622.46, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20622.46 } ] } ] }, { "description": "Atezolizumab IV Soln 1200 MG/20ML", "drug_information": { "unit": 20.0, "type": "ML" }, "code_information": [ { "code": "50242091701", "type": "NDC" }, { "code": "J9022", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 281.5785, "maximum": 1130.28, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1130.28 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 419.94 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 335.95 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 419.94 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 419.94 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 281.58 } ] } ] }, { "description": "PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC", "code_information": [ { "code": "273", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8294.0, "minimum": 8294.44, "maximum": 48635.44, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 48635.44 } ] } ] }, { "description": "HC X-RAY SPINE ONE VIEW", "code_information": [ { "code": "72020", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 426.56, "discounted_cash": 123.0, "minimum": 61.5, "maximum": 386.8899, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 62.74 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 76.87 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 61.5 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 76.87 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 76.87 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 141.02 } ] } ] }, { "description": "HC XRAY UPPER GI TRACT", "code_information": [ { "code": "74240", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1357.19, "discounted_cash": 393.0, "minimum": 281.72, "maximum": 1230.9713, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 287.39 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 352.15 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 281.72 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 352.15 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 352.15 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 719.05 } ] } ] }, { "description": "HC (SUP SHELL L3980) UPP EXT FX ORTHOSIS HUMERAL", "code_information": [ { "code": "L3980", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 463.5, "maximum": 463.5, "payers_information": [ { "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" } ] } ] }, { "description": "HC CT SCAN,ABDOMEN,W/O CONTRAST", "code_information": [ { "code": "74150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2172.19, "discounted_cash": 629.0, "minimum": 629.9351, "maximum": 1970.1763, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 1193.28, "10th_percentile": 1193.28, "90th_percentile": 1193.28, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 963.52 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 770.82 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 963.52 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 963.52 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 713.38 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 469.04, "10th_percentile": 469.04, "90th_percentile": 498.36, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1553.75, "10th_percentile": 1465.75, "90th_percentile": 1553.75, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 497.2, "10th_percentile": 497.2, "90th_percentile": 497.2, "count": "1 through 10" } ] } ] }, { "description": "HC MICROALBUMIN, QUANTITATIVE", "code_information": [ { "code": "82043", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 158.75, "discounted_cash": 46.0, "minimum": 5.78, "maximum": 143.9863, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 86.82, "10th_percentile": 86.82, "90th_percentile": 86.82, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 43.65, "10th_percentile": 43.65, "90th_percentile": 43.65, "count": "43" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 44.15 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 54.1 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 42.05, "10th_percentile": 42.05, "90th_percentile": 42.05, "count": "40" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 43.28 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 54.1 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 54.1 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 77.24, "10th_percentile": 77.24, "90th_percentile": 77.24, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 95.3, "10th_percentile": 95.3, "90th_percentile": 97.13, "count": "13" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 53.58 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 34.88, "10th_percentile": 15.68, "90th_percentile": 116.93, "count": "36" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 28.18, "10th_percentile": 28.18, "90th_percentile": 28.18, "count": "1 through 10" }, { "payer_name": "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 121.25, "10th_percentile": 121.25, "90th_percentile": 121.25, "count": "53" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 38.8, "10th_percentile": 38.8, "90th_percentile": 38.8, "count": "104" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 111.06, "10th_percentile": 109.97, "90th_percentile": 111.07, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 38.8, "10th_percentile": 38.8, "90th_percentile": 44.86, "count": "105" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 38.8, "10th_percentile": 38.8, "90th_percentile": 38.8, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 38.8, "10th_percentile": 38.8, "90th_percentile": 41.23, "count": "58" } ] } ] }, { "description": "HC ASSAY VIT D, 25-HYDROXY W FRACTIONS", "code_information": [ { "code": "82306", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 140.31, "discounted_cash": 40.0, "minimum": 29.6, "maximum": 140.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 80.37, "10th_percentile": 80.37, "90th_percentile": 80.37, "count": "12" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 40.41, "10th_percentile": 40.41, "90th_percentile": 40.41, "count": "31" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 140.31 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 140.31 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 38.93, "10th_percentile": 38.93, "90th_percentile": 38.93, "count": "25" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 140.31 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 140.31 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 140.31 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 71.5, "10th_percentile": 71.5, "90th_percentile": 71.5, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 88.23, "10th_percentile": 88.23, "90th_percentile": 89.92, "count": "22" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 140.31 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 95.14, "10th_percentile": 14.16, "90th_percentile": 112.25, "count": "16" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 26.09, "10th_percentile": 26.09, "90th_percentile": 26.09, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 112.25, "10th_percentile": 112.25, "90th_percentile": 112.25, "count": "208" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 35.92, "10th_percentile": 35.92, "90th_percentile": 35.92, "count": "65" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 101.81, "10th_percentile": 89.72, "90th_percentile": 102.82, "count": "19" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 35.92, "10th_percentile": 35.92, "90th_percentile": 35.92, "count": "71" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 35.92, "10th_percentile": 35.92, "90th_percentile": 38.17, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 35.92, "10th_percentile": 35.92, "90th_percentile": 38.17, "count": "29" } ] } ] }, { "description": "HC ANGIO ADRENAL BILAT SELECT", "code_information": [ { "code": "75733", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1634.06, "discounted_cash": 473.0, "minimum": 473.8774, "maximum": 1482.0924, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1057.66 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1296.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1036.79 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1296.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1296.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 950.28 } ] } ] }, { "description": "DENTAL AND ORAL DISEASES WITHOUT CCMCC", "code_information": [ { "code": "159", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4707.0, "minimum": 4707.65, "maximum": 8352.49, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8352.49 } ] } ] }, { "description": "TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC", "code_information": [ { "code": "082", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9863.0, "minimum": 9863.66, "maximum": 26944.89, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26944.89 } ] } ] }, { "description": "DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC", "code_information": [ { "code": "441", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10312.0, "minimum": 6739.5365, "maximum": 21157.68, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21157.68 } ] } ] }, { "description": "CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC", "code_information": [ { "code": "233", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24659.0, "minimum": 24659.14, "maximum": 90129.11, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 90129.11 } ] } ] }, { "description": "DENTAL AND ORAL DISEASES WITH MCC", "code_information": [ { "code": "157", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10087.0, "minimum": 10087.83, "maximum": 20239.32, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20239.32 } ] } ] }, { "description": "RESPIRATORY NEOPLASMS WITH CC", "code_information": [ { "code": "181", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6949.0, "minimum": 6949.39, "maximum": 12626.0, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12626.0 } ] } ] }, { "description": "TESTES PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "712", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5156.0, "minimum": 5156.0, "maximum": 12964.34, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12964.34 } ] } ] }, { "description": "ADRENAL AND PITUITARY PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "615", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3138.0, "minimum": 3138.44, "maximum": 16496.32, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16496.32 } ] } ] }, { "description": "OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "423", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18158.0, "minimum": 18158.09, "maximum": 48959.63, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 48959.63 } ] } ] }, { "description": "HC NM BRAIN IMAGING MIN 4 STATIC VIEWS W VASCULAR FLW", "code_information": [ { "code": "78606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1752.19, "discounted_cash": 508.0, "minimum": 508.1351, "maximum": 1752.19, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1066.4 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1306.71 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1045.36 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1306.71 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1306.71 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1752.19 } ] } ] }, { "description": "Bupivacaine HCl Preservative Free (PF) Inj 0.25%", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "63323046401", "type": "NDC" }, { "code": "J0665", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC DNA/RNA AMPLIFIED PROBE", "code_information": [ { "code": "87150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 221.25, "discounted_cash": 64.0, "minimum": 35.09, "maximum": 221.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 210.92 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 221.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 206.76 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 221.25 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 221.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 221.25 }, { "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" } ] } ] }, { "description": "GASTROINTESTINAL OBSTRUCTION WITH CC", "code_information": [ { "code": "389", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6501.0, "minimum": 6501.05, "maximum": 13164.48, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9310.94 } ] } ] }, { "description": "HC (SUP SHELL Q4049) FINGER SPLINT, STATIC", "code_information": [ { "code": "Q4049", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2.68, "maximum": 2.68, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2.68, "additional_payer_notes": "100.00% 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": 5156.0, "minimum": 5156.0, "maximum": 19515.48, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19515.48 } ] } ] }, { "description": "HC THYROID MET IMAGING LTD", "code_information": [ { "code": "78015", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1523.44, "discounted_cash": 441.0, "minimum": 441.7976, "maximum": 1523.44, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 675.46 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 827.67 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 662.13 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 827.67 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 827.67 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1523.44 } ] } ] }, { "description": "HC MRA PELVIS W CONTRAST - 72198 - 61800007", "code_information": [ { "code": "72198", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2630.0, "discounted_cash": 762.0, "minimum": 762.7, "maximum": 2385.41, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2118.32 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1694.64 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2118.32 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2118.32 }, { "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": 2236.09 } ] } ] }, { "description": "HC (SUP SHELL A4416) OST PCH CLSD W BARRIER/FILTR", "code_information": [ { "code": "A4416", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 3.93, "maximum": 3.93, "payers_information": [ { "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" } ] } ] }, { "description": "HC NM TUMOR IMAGING SPECT", "code_information": [ { "code": "78803", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6184.69, "discounted_cash": 1793.0, "minimum": 1161.22, "maximum": 5609.5138, "payers_information": [ { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1451.53 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2520.86 }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1184.59 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1451.53 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1161.22 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1451.53 } ] } ] }, { "description": "HC M.PNEUMON DNA AMP PROBE", "code_information": [ { "code": "87581", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 76.25, "discounted_cash": 22.0, "minimum": 22.1125, "maximum": 76.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 76.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 76.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 76.25 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 76.25 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 76.25 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 47.15, "10th_percentile": 47.15, "90th_percentile": 47.15, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 46.06, "10th_percentile": 46.06, "90th_percentile": 46.06, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 76.25 }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 57.5, "10th_percentile": 57.5, "90th_percentile": 61.0, "count": "50" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 18.4, "10th_percentile": 18.4, "90th_percentile": 18.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 55.33, "10th_percentile": 55.33, "90th_percentile": 110.66, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 19.52, "10th_percentile": 18.4, "90th_percentile": 21.28, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 19.55, "10th_percentile": 19.55, "90th_percentile": 19.55, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 19.55, "10th_percentile": 19.55, "90th_percentile": 19.55, "count": "1 through 10" } ] } ] }, { "description": "CONCOMITANT AORTIC AND MITRAL VALVE PROCEDURES", "code_information": [ { "code": "212", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 28021.0, "minimum": 28021.75, "maximum": 128194.55, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 128194.55 } ] } ] }, { "description": "HC ASSAY OF PROGESTERONE 17-D", "code_information": [ { "code": "83498", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 275.31, "discounted_cash": 79.0, "minimum": 27.17, "maximum": 274.72, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 274.72 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 219.78 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 274.72 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 274.72 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 251.88 }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 220.25, "10th_percentile": 220.25, "90th_percentile": 220.25, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 199.77, "10th_percentile": 199.77, "90th_percentile": 199.77, "count": "1 through 10" } ] } ] }, { "description": "HC NM MYOCARDIAL SPECT MULTIPLE STUDIES", "code_information": [ { "code": "78452", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4980.31, "discounted_cash": 1444.0, "minimum": 1191.23, "maximum": 4517.1412, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1215.21 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1489.05 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1191.23 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1489.05 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1489.05 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3036.88 } ] } ] }, { "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": 57.0, "minimum": 17.14, "maximum": 181.1188, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 107.94, "10th_percentile": 107.94, "90th_percentile": 116.83, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 90.62 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 111.04 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 88.83 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 111.04 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 111.04 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 158.9 }, { "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" } ] } ] }, { "description": "HC FMR1 GENE ANAL CHARACTERIZATION OF ALLELES", "code_information": [ { "code": "81244", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1736.88, "discounted_cash": 503.0, "minimum": 44.89, "maximum": 1575.3502, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 159.42 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 195.34 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 156.27 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 195.34 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 195.34 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 416.15 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 44.89, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MASTECTOMY FOR MALIGNANCY WITH CCMCC", "code_information": [ { "code": "582", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5828.0, "minimum": 5828.52, "maximum": 22712.65, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22712.65 } ] } ] }, { "description": "HC (SUP SHELL A6197) ALGINATE DRSG >16 <=48 SQ IN - A6197 - 27200112", "code_information": [ { "code": "A6197", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 23.44, "maximum": 23.44, "payers_information": [ { "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" } ] } ] }, { "description": "HC X-RAY LEG, INFANT", "code_information": [ { "code": "73592", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 596.56, "discounted_cash": 173.0, "minimum": 77.24, "maximum": 541.0799, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 78.79 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 96.55 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 77.24 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 96.55 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 96.55 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 203.03 } ] } ] }, { "description": "HC ASSAY OF SIROLIMUS", "code_information": [ { "code": "80195", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 177.81, "discounted_cash": 51.0, "minimum": 13.73, "maximum": 161.2737, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 60.15 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 73.7 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 58.96 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 73.7 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 73.7 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 127.28 }, { "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" } ] } ] }, { "description": "HC PCA3/KLK3 PROSTATE SPECIFIC ANTIGEN RATIO", "code_information": [ { "code": "81313", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1597.81, "discounted_cash": 463.0, "minimum": 255.05, "maximum": 1597.81, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1597.81 }, { "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" } ] } ] }, { "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": 201.0, "minimum": 201.55, "maximum": 630.365, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 427.01, "10th_percentile": 427.01, "90th_percentile": 427.01, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 309.28 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 247.42 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 309.28 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 309.28 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 592.16 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 556.0, "10th_percentile": 524.5, "90th_percentile": 556.0, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 504.29, "10th_percentile": 504.29, "90th_percentile": 504.29, "count": "1 through 10" } ] } ] }, { "description": "HC BLOOD CLOT FACTOR XI TEST", "code_information": [ { "code": "85270", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 333.44, "discounted_cash": 96.0, "minimum": 17.9, "maximum": 302.4301, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 147.77 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 181.07 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 144.86 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 181.07 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 181.07 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 165.94 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MAJOR ESOPHAGEAL DISORDERS WITH MCC", "code_information": [ { "code": "368", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8966.0, "minimum": 8966.96, "maximum": 18766.88, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18766.88 } ] } ] }, { "description": "Thiamine HCl Inj 100 MG/ML", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "65145012901", "type": "NDC" }, { "code": "J3411", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 5.544, "maximum": 42.79, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 42.79 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.27 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6.61 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 8.27 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 8.27 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.54 } ] } ] }, { "description": "HC X-RAY HAND 3+ VW", "code_information": [ { "code": "73130", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 513.44, "discounted_cash": 148.0, "minimum": 85.8, "maximum": 465.6901, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 277.45, "10th_percentile": 277.45, "90th_percentile": 277.45, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 147.87, "10th_percentile": 139.5, "90th_percentile": 147.87, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 87.53 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 107.26 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 142.45, "10th_percentile": 142.45, "90th_percentile": 142.45, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 85.8 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 107.26 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 107.26 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 261.65, "10th_percentile": 261.65, "90th_percentile": 329.01, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 310.43, "10th_percentile": 310.43, "90th_percentile": 310.43, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 245.3 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 131.75, "10th_percentile": 131.44, "90th_percentile": 387.5, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 176.79, "10th_percentile": 176.79, "90th_percentile": 176.79, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 410.75, "10th_percentile": 387.5, "90th_percentile": 410.75, "count": "92" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 131.44, "10th_percentile": 124.0, "90th_percentile": 131.44, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 354.95, "10th_percentile": 354.95, "90th_percentile": 372.55, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 131.44, "10th_percentile": 124.0, "90th_percentile": 280.51, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 131.44, "10th_percentile": 124.0, "90th_percentile": 263.5, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 131.44, "10th_percentile": 131.44, "90th_percentile": 131.75, "count": "1 through 10" } ] } ] }, { "description": "HC HPV TYPES 16 & 18 ONLY", "code_information": [ { "code": "87625", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 381.56, "discounted_cash": 110.0, "minimum": 40.55, "maximum": 375.9188, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 206.21, "10th_percentile": 206.21, "90th_percentile": 206.21, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 200.4 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 245.56 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 196.45 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 245.56 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 245.56 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 375.92 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 40.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 288.0, "10th_percentile": 288.0, "90th_percentile": 305.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 92.16, "10th_percentile": 92.16, "90th_percentile": 97.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 97.68, "10th_percentile": 97.68, "90th_percentile": 97.68, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 92.16, "10th_percentile": 92.16, "90th_percentile": 92.16, "count": "1 through 10" } ] } ] }, { "description": "Dextrose 5% w/ Sodium Chloride 0.9%", "drug_information": { "unit": 1000.0, "type": "ML" }, "code_information": [ { "code": "00338008904", "type": "NDC" }, { "code": "J7042", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 3.9375, "maximum": 14.84, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.84 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.87 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.7 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 5.87 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 5.87 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.94 } ] } ] }, { "description": "HC URINARY BLADDER RESIDUAL STUDY", "code_information": [ { "code": "78730", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 212.81, "discounted_cash": 61.0, "minimum": 61.7149, "maximum": 212.81, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 212.81 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 212.81 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 212.81 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 212.81 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 212.81 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 212.81 } ] } ] }, { "description": "PULMONARY EDEMA AND RESPIRATORY FAILURE", "code_information": [ { "code": "189", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7846.0, "minimum": 7315.4373, "maximum": 14564.11, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 7846.09, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 10719.1, "10th_percentile": 10719.1, "90th_percentile": 10719.1, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14564.11 } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC", "code_information": [ { "code": "217", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9639.0, "minimum": 9639.48, "maximum": 77516.08, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 77516.08 } ] } ] }, { "description": "HC (SUP SHELL A6234) HYDROCOLLD DRG <=16 W/O BDR - A6234 - 27200131", "code_information": [ { "code": "A6234", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 9.33, "maximum": 19.45, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.45 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 15.56 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 19.45 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 19.45 }, { "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" } ] } ] }, { "description": "HC ASSAY OF SEROTONIN", "code_information": [ { "code": "84260", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 390.94, "discounted_cash": 113.0, "minimum": 30.98, "maximum": 354.5826, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 255.69 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 313.31 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 250.65 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 313.31 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 313.31 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 287.2 }, { "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" } ] } ] }, { "description": "HC HISTOPLASMA CAPSUL AG, EIA", "code_information": [ { "code": "87385", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 207.81, "discounted_cash": 60.0, "minimum": 13.25, "maximum": 188.4837, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 94.58 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 115.89 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 92.71 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 115.89 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 115.89 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 122.83 }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 156.75, "10th_percentile": 156.75, "90th_percentile": 156.75, "count": "1 through 10" } ] } ] }, { "description": "HC ASSAY OF TESTOSTERONE", "code_information": [ { "code": "84402", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 447.19, "discounted_cash": 129.0, "minimum": 25.47, "maximum": 405.6013, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 210.18 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 257.55 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 206.04 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 257.55 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 257.55 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 236.12 }, { "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" } ] } ] }, { "description": "HC (SUP SHELL Q4133) GRAFIX PRIME", "code_information": [ { "code": "Q4133", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 429.5655, "maximum": 1947.34, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1947.34 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 640.64 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 512.51 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 640.64 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 640.64 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 429.57 } ] } ] }, { "description": "HC SURG PATH,LEVEL IV", "code_information": [ { "code": "88305", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 462.19, "discounted_cash": 134.0, "minimum": 134.0351, "maximum": 419.2063, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 264.74, "10th_percentile": 264.74, "90th_percentile": 1058.96, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 409.57 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 85.95, "10th_percentile": 85.95, "90th_percentile": 85.95, "count": "1 through 10" } ] } ] }, { "description": "NEUROSES EXCEPT DEPRESSIVE", "code_information": [ { "code": "882", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7621.0, "minimum": 7621.92, "maximum": 12659.01, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12659.01 } ] } ] }, { "description": "HC ASSAY OF CYCLOSPORINE", "code_information": [ { "code": "80158", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 336.88, "discounted_cash": 97.0, "minimum": 18.05, "maximum": 305.5502, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 167.33 }, { "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": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 149.02 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 182.6 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 146.08 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 182.6 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 182.6 } ] } ] }, { "description": "HC MRI CHEST W/CONTRAST", "code_information": [ { "code": "71551", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2698.75, "discounted_cash": 782.0, "minimum": 782.6375, "maximum": 2566.0036, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2118.32 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1694.64 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2118.32 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2118.32 }, { "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": 2566.0 } ] } ] }, { "description": "INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS", "code_information": [ { "code": "065", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6276.0, "minimum": 6276.87, "maximum": 20580.201, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 6276.87, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 8575.28, "10th_percentile": 8575.28, "90th_percentile": 8575.28, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11910.41 } ] } ] }, { "description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CCMCC", "code_information": [ { "code": "848", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5828.0, "minimum": 5828.52, "maximum": 10013.56, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10013.56 } ] } ] }, { "description": "PLEURAL EFFUSION WITH MCC", "code_information": [ { "code": "186", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9415.0, "minimum": 9415.31, "maximum": 18373.13, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "other", "standard_charge_dollar": 9415.31, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 6720.0, "10th_percentile": 6720.0, "90th_percentile": 6720.0, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18373.13 } ] } ] }, { "description": "HC HFE GENE", "code_information": [ { "code": "81256", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 419.69, "discounted_cash": 121.0, "minimum": 65.36, "maximum": 419.69, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 419.69 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 419.69 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 419.69 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 419.69 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 419.69 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 419.69 }, { "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" } ] } ] }, { "description": "FRACTURES OF HIP AND PELVIS WITH MCC", "code_information": [ { "code": "535", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8742.0, "minimum": 8742.79, "maximum": 15113.47, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15113.47 } ] } ] }, { "description": "HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC", "code_information": [ { "code": "001", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 57836.0, "minimum": 57836.89, "maximum": 330373.2, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 330373.2 } ] } ] }, { "description": "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": 11.466, "maximum": 65.98, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 65.98 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.29 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 13.83 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 17.29 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 17.29 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.47 } ] } ] }, { "description": "HC X-RAY OPER CHOLANGIOGRAM", "code_information": [ { "code": "74300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1267.5, "discounted_cash": 367.0, "minimum": 135.84, "maximum": 1149.6225, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 138.58 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 169.81 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 135.84 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 169.81 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 169.81 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 203.03 } ] } ] }, { "description": "TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CCMCC", "code_information": [ { "code": "084", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4707.0, "minimum": 4707.65, "maximum": 11267.91, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11267.91 } ] } ] }, { "description": "HC X-RAY RETROGRADE PYELOGRAM", "code_information": [ { "code": "74420", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1925.0, "discounted_cash": 558.0, "minimum": 421.89, "maximum": 1745.975, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 430.38 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 527.36 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 421.89 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 527.36 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 527.36 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 456.81 } ] } ] }, { "description": "SEPTIC ARTHRITIS WITH MCC", "code_information": [ { "code": "548", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13226.0, "minimum": 13226.27, "maximum": 22763.34, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22763.34 } ] } ] }, { "description": "HC FUNGUS ISOLATION CULTURE", "code_information": [ { "code": "87102", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 210.94, "discounted_cash": 61.0, "minimum": 8.41, "maximum": 191.3226, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 69.31 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 84.93 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 67.94 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 84.93 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 84.93 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 77.96 }, { "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 Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 8.41, "10th_percentile": 8.41, "90th_percentile": 8.41, "count": "1 through 10" } ] } ] }, { "description": "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": 541.0, "minimum": 541.7577, "maximum": 1868.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 388.8, "10th_percentile": 388.8, "90th_percentile": 388.8, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1868.13 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 345.6, "10th_percentile": 345.6, "90th_percentile": 345.6, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL L0627) LO SAG RI AN/POS PNL PRE CST", "code_information": [ { "code": "L0627", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 493.08, "maximum": 493.08, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 493.08, "additional_payer_notes": "100.00% 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": 77.0, "minimum": 13.25, "maximum": 240.9264, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 76.5, "10th_percentile": 72.18, "90th_percentile": 76.5, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 102.26 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 125.31 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 73.7, "10th_percentile": 73.7, "90th_percentile": 73.7, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 100.25 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 125.31 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 125.31 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 122.83 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 158.88, "10th_percentile": 158.88, "90th_percentile": 158.88, "count": "1 through 10" }, { "payer_name": "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 12.66, "10th_percentile": 12.66, "90th_percentile": 12.66, "count": "11" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 68.0, "10th_percentile": 64.16, "90th_percentile": 68.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 64.16, "10th_percentile": 64.16, "90th_percentile": 68.0, "count": "1 through 10" } ] } ] }, { "description": "HC ARTHROGRAM OF ANKLE", "code_information": [ { "code": "73615", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1090.63, "discounted_cash": 316.0, "minimum": 280.29, "maximum": 989.2014, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 285.93 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 350.37 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 280.29 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 350.37 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 350.37 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 854.4 } ] } ] }, { "description": "HC (SUP SHELL L4360) PNEUMAT WALKING BOOT PRE CST", "code_information": [ { "code": "L4360", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 424.24, "maximum": 424.24, "payers_information": [ { "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" } ] } ] }, { "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": "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" } ] } ] }, { "description": "HC ASSAY GLUCOSE, BODY FLUID", "code_information": [ { "code": "82945", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 71.25, "discounted_cash": 20.0, "minimum": 3.93, "maximum": 64.6238, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 32.39 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 39.69 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 19.77, "10th_percentile": 19.77, "90th_percentile": 19.77, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 31.75 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 39.69 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 39.69 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.43 }, { "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": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 18.24, "10th_percentile": 18.24, "90th_percentile": 18.24, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL Q4238) DERM-MAXX, PER SQ CM", "code_information": [ { "code": "Q4238", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 5181.7185, "maximum": 7319.13, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7319.13 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 5855.24 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 7319.13 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 7319.13 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5181.72 } ] } ] }, { "description": "HC COMPLEMENT, TOTAL (CH50)", "code_information": [ { "code": "86162", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 315.31, "discounted_cash": 91.0, "minimum": 20.32, "maximum": 285.9862, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 167.73 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 205.52 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 164.42 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 205.52 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 205.52 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 188.38 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC PHENOTYPE DNA HIV W/CLT, EA ADD", "code_information": [ { "code": "87904", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 130.31, "discounted_cash": 37.0, "minimum": 26.07, "maximum": 130.31, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 130.31 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 130.31 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 130.31 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 130.31 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 130.31 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 130.31 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% 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": 205.0, "minimum": 205.175, "maximum": 641.7025, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 348.29 } ] } ] }, { "description": "HC (SUP SHELL A6022) COLLAGEN DRSG>16<=48 SQ IN - A6022 - RU272039", "code_information": [ { "code": "A6022", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 29.97, "maximum": 29.97, "payers_information": [ { "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" } ] } ] }, { "description": "HC (SUP SHELL C9364) PORCINE IMPLANT, PERMACOL", "code_information": [ { "code": "C9364", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 57.9285, "maximum": 57.9285, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 57.93 } ] } ] }, { "description": "HC INFECT AGENT DNA/RNA INFLUENZA FIRST 2 TYPES", "code_information": [ { "code": "87502", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 479.06, "discounted_cash": 138.0, "minimum": 95.8, "maximum": 479.06, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 447.16 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 479.06 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 438.34 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 479.06 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 479.06 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 479.06 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 95.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 383.25, "10th_percentile": 383.25, "90th_percentile": 383.25, "count": "1 through 10" } ] } ] }, { "description": "Azithromycin IV For Soln 500 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "55150017410", "type": "NDC" }, { "code": "J0456", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 6.993, "maximum": 44.82, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 44.82 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.43 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8.34 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 10.43 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 10.43 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.99 } ] } ] }, { "description": "HC (SUP SHELL A4222) INFUSION SUPPLIES WITH PUMP", "code_information": [ { "code": "A4222", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 49.07, "maximum": 49.07, "payers_information": [ { "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" } ] } ] }, { "description": "HC CYTOMEG, DNA, AMP PROBE", "code_information": [ { "code": "87496", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 491.25, "discounted_cash": 142.0, "minimum": 35.09, "maximum": 445.5638, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 214.99 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 263.43 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 210.75 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 263.43 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 263.43 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 325.3 }, { "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": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 118.64, "10th_percentile": 118.64, "90th_percentile": 118.64, "count": "1 through 10" } ] } ] }, { "description": "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": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC MR SAFETY IMPLANT&/FB ASSMT CLIN STAF 1ST 15 MIN", "code_information": [ { "code": "76014", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 91.88, "discounted_cash": 26.0, "minimum": 26.6452, "maximum": 91.88, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 91.88 } ] } ] }, { "description": "HC X-RAY SKULL 4+ VW", "code_information": [ { "code": "70260", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 775.0, "discounted_cash": 224.0, "minimum": 121.57, "maximum": 702.925, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 124.02 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 151.96 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 121.57 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 151.96 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 151.96 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 265.04 } ] } ] }, { "description": "NON-MALIGNANT BREAST DISORDERS WITH CCMCC", "code_information": [ { "code": "600", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7173.0, "minimum": 7173.57, "maximum": 12279.4, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12279.4 } ] } ] }, { "description": "HC HEP A AB TEST, IGM", "code_information": [ { "code": "86709", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 228.75, "discounted_cash": 66.0, "minimum": 11.26, "maximum": 207.4762, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 123.69, "10th_percentile": 123.69, "90th_percentile": 123.69, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 92.94 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 113.88 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 59.91, "10th_percentile": 59.91, "90th_percentile": 59.91, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 91.1 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 113.88 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 113.88 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 143.84, "10th_percentile": 143.84, "90th_percentile": 143.84, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 104.39 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 172.75, "10th_percentile": 172.75, "90th_percentile": 183.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 55.28, "10th_percentile": 55.28, "90th_percentile": 55.28, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 55.28, "10th_percentile": 55.28, "90th_percentile": 55.28, "count": "1 through 10" } ] } ] }, { "description": "Cefepime HCl For Inj 1 GM", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "60505614600", "type": "NDC" }, { "code": "J0692", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 3.78, "maximum": 36.73, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 36.73 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.64 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 4.51 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 5.64 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 5.64 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.78 } ] } ] }, { "description": "UNCOMPLICATED PEPTIC ULCER WITH MCC", "code_information": [ { "code": "383", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8742.0, "minimum": 8742.79, "maximum": 16277.04, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16277.04 } ] } ] }, { "description": "Tetanus-Diphtheria Toxoids (Td) Inj 5-2 LF/0.5ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "49281021515", "type": "NDC" }, { "code": "90714", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 106.974, "maximum": 348.65, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 67.23, "10th_percentile": 67.23, "90th_percentile": 67.23, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 348.65 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 159.54 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 127.63 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 159.54 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 159.54 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.1, "median_amount": 153.13, "10th_percentile": 153.13, "90th_percentile": 153.13, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 106.97 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 186.74, "10th_percentile": 186.74, "90th_percentile": 186.74, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 59.76, "10th_percentile": 59.76, "90th_percentile": 59.76, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL A6223) GAUZE >16<=48 NO W/SAL W/O B - A6223 - RU272048", "code_information": [ { "code": "A6223", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 3.46, "maximum": 3.46, "payers_information": [ { "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" } ] } ] }, { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC", "code_information": [ { "code": "439", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6501.0, "minimum": 6501.05, "maximum": 16102.5179, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "other", "standard_charge_dollar": 6793.6, "standard_charge_algorithm": "2342.62 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 8639.35, "10th_percentile": 8639.35, "90th_percentile": 8639.35, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 6501.05, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 48748.0, "10th_percentile": 48748.0, "90th_percentile": 48748.0, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9916.89 } ] } ] }, { "description": "HC (SUP SHELL A4409) OST SKN BARR CONVEX <=4 SQ I", "code_information": [ { "code": "A4409", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 8.84, "maximum": 8.84, "payers_information": [ { "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" } ] } ] }, { "description": "Triamcinolone Acetonide Inj Susp 10 MG/ML", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "00003049420", "type": "NDC" }, { "code": "J3301", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2.7405, "maximum": 26.03, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 26.03 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.09 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3.27 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 4.09 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 4.09 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2.74 } ] } ] }, { "description": "HC (SUP SHELL A6403) STERILE GAUZE>16 <= 48 SQ IN - A6403 - 27200153", "code_information": [ { "code": "A6403", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "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" } ] } ] }, { "description": "HC CYTOMEG DNA QUANT", "code_information": [ { "code": "87497", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 766.56, "discounted_cash": 222.0, "minimum": 42.84, "maximum": 695.2699, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 353.54 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 433.21 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 346.57 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 433.21 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 433.21 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 397.15 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 196.24, "10th_percentile": 196.24, "90th_percentile": 196.24, "count": "1 through 10" } ] } ] }, { "description": "Lactated Ringer's Solution - 00338011704 - 25800001", "drug_information": { "unit": 1000.0, "type": "ML" }, "code_information": [ { "code": "00338011704", "type": "NDC" }, { "code": "J7120", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 7.245, "maximum": 39.26, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 39.26 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.85 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 8.68 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 10.85 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 10.85 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.25 } ] } ] }, { "description": "UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC", "code_information": [ { "code": "736", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13674.0, "minimum": 13674.61, "maximum": 42139.71, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 42139.71 } ] } ] }, { "description": "CARDIAC ARREST, UNEXPLAINED WITH CC", "code_information": [ { "code": "297", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 2914.0, "minimum": 2914.26, "maximum": 7474.21, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7474.21 } ] } ] }, { "description": "HC (SUP SHELL L0462) TLSO 3MOD SACRO-SCAP PRE", "code_information": [ { "code": "L0462", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1497.69, "maximum": 1497.69, "payers_information": [ { "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" } ] } ] }, { "description": "HC NM BONE IMAGING, 3 PHASE", "code_information": [ { "code": "78315", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1769.06, "discounted_cash": 513.0, "minimum": 513.0274, "maximum": 1769.06, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 994.92 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1219.13 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 975.3 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1219.13 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1219.13 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1769.06 } ] } ] }, { "description": "MINOR SKIN DISORDERS WITHOUT MCC", "code_information": [ { "code": "607", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6501.0, "minimum": 6501.05, "maximum": 12948.12, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10685.53 } ] } ] }, { "description": "HC DIGITAL BREAST TOMOSYNTHESIS UNILAT - G0279 - 40100010", "code_information": [ { "code": "G0279", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 501.88, "minimum": 11.68, "maximum": 722.7702, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 81.75 }, { "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" } ] } ] }, { "description": "REHABILITATION WITHOUT CCMCC", "code_information": [ { "code": "946", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9863.0, "minimum": 9863.66, "maximum": 13519.6, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13519.6 } ] } ] }, { "description": "HC ARC BLOOD TYPING, RH (D)", "code_information": [ { "code": "86901", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 57.81, "discounted_cash": 16.0, "minimum": 16.7649, "maximum": 52.4337, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 33.12, "10th_percentile": 33.12, "90th_percentile": 33.12, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 24.59 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 30.13 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 24.11 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 30.13 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 30.13 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.72 } ] } ] }, { "description": "SKIN GRAFTS FOR INJURIES WITHOUT CCMCC", "code_information": [ { "code": "905", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6725.0, "minimum": 6725.22, "maximum": 17487.77, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17487.77 } ] } ] }, { "description": "HC CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP VAR", "code_information": [ { "code": "81229", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2755.0, "discounted_cash": 798.0, "minimum": 93.76, "maximum": 2755.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 95.65 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 117.2 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 93.76 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 117.2 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 117.2 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2755.0 }, { "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" } ] } ] }, { "description": "LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "820", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23986.0, "minimum": 23986.62, "maximum": 69140.01, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 69140.01 } ] } ] }, { "description": "CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC", "code_information": [ { "code": "258", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12105.0, "minimum": 12105.4, "maximum": 37042.15, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 37042.15 } ] } ] }, { "description": "HC PULMONARY VENTILATION IMAGING", "code_information": [ { "code": "78579", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 891.56, "discounted_cash": 258.0, "minimum": 258.5524, "maximum": 891.56, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 612.68 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 750.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 600.59 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 750.75 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 750.75 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 891.56 } ] } ] }, { "description": "Leuprolide Acetate (3 Month) For Subcutaneous Inj Kit 22.5MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "62935022710", "type": "NDC" }, { "code": "J9217", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 542.7135, "maximum": 3206.67, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 2847.34, "10th_percentile": 2847.34, "90th_percentile": 2847.34, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3206.67 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 809.38 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 647.5 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 809.38 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 809.38 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 542.71 } ] } ] }, { "description": "HC (SUP SHELL A6450) LT COMPRES BAND >=5/YD - A6450 - 27100026", "code_information": [ { "code": "A6450", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2.5, "maximum": 2.5, "payers_information": [ { "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" } ] } ] }, { "description": "HC CT SCAN OF PELVIS COMBO", "code_information": [ { "code": "72194", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3336.25, "discounted_cash": 967.0, "minimum": 650.0, "maximum": 3025.9788, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 906.48, "10th_percentile": 906.48, "90th_percentile": 906.48, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1691.07 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1352.85 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1691.07 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1691.07 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1714.4 } ] } ] }, { "description": "HC FACTOR INHIBITOR TEST", "code_information": [ { "code": "85335", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 601.25, "discounted_cash": 174.0, "minimum": 12.87, "maximum": 545.3338, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 106.28 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 130.23 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 104.18 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 130.23 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 130.23 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 119.31 }, { "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" } ] } ] }, { "description": "SOFT TISSUE PROCEDURES WITH MCC", "code_information": [ { "code": "500", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17037.0, "minimum": 17037.22, "maximum": 37309.76, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 37309.76 } ] } ] }, { "description": "HC ANALYSIS, NERVE", "code_information": [ { "code": "88356", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1181.56, "discounted_cash": 342.0, "minimum": 342.6524, "maximum": 1181.56, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1181.56 } ] } ] }, { "description": "HC GIARDIA AG EIA", "code_information": [ { "code": "87329", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 165.94, "discounted_cash": 48.0, "minimum": 11.98, "maximum": 150.5076, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 94.58 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 115.89 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 92.71 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 115.89 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 115.89 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 111.06 }, { "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" } ] } ] }, { "description": "COMPLICATIONS OF TREATMENT WITH MCC", "code_information": [ { "code": "919", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9639.0, "minimum": 9639.48, "maximum": 21583.26, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21583.26 } ] } ] }, { "description": "FOOT PROCEDURES WITH MCC", "code_information": [ { "code": "503", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15916.0, "minimum": 15916.35, "maximum": 32904.22, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 32904.22 } ] } ] }, { "description": "HC MUMPS", "code_information": [ { "code": "86735", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 100.94, "discounted_cash": 29.0, "minimum": 13.05, "maximum": 100.94, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 100.94 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 100.94 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 100.94 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 100.94 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 100.94 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 100.94 }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 76.25, "10th_percentile": 76.25, "90th_percentile": 80.75, "count": "11" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 25.84, "10th_percentile": 24.4, "90th_percentile": 25.84, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 69.85, "10th_percentile": 69.85, "90th_percentile": 73.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 25.84, "10th_percentile": 25.84, "90th_percentile": 25.84, "count": "1 through 10" } ] } ] }, { "description": "HC CSF VENTRICULOGRAPHY", "code_information": [ { "code": "78635", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1237.5, "discounted_cash": 358.0, "minimum": 358.875, "maximum": 1237.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1028.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1237.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1008.21 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1237.5 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1237.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1237.5 } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC", "code_information": [ { "code": "617", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12553.0, "minimum": 12553.74, "maximum": 22048.93, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22048.93 } ] } ] }, { "description": "HC CT UPPER EXTREMITY W CONTRAST", "code_information": [ { "code": "73201", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2008.13, "discounted_cash": 582.0, "minimum": 582.3577, "maximum": 1821.3739, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1312.06 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 557.13, "10th_percentile": 557.13, "90th_percentile": 557.13, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1049.64 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1312.06 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1312.06 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1283.0 } ] } ] }, { "description": "HC CMV ANTIBODY", "code_information": [ { "code": "86644", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 226.25, "discounted_cash": 65.0, "minimum": 14.39, "maximum": 205.2088, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 118.83 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 145.61 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 116.48 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 145.61 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 145.61 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 133.4 }, { "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" } ] } ] }, { "description": "LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CCMCC", "code_information": [ { "code": "842", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5828.0, "minimum": 5828.52, "maximum": 11911.59, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11911.59 } ] } ] }, { "description": "HC (SUP SHELL A6242) HYDROGEL DRG <=16 IN W/O BDR", "code_information": [ { "code": "A6242", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 8.63, "maximum": 8.63, "payers_information": [ { "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" } ] } ] }, { "description": "HC XRAY UPPER GI AIR CONTRAST", "code_information": [ { "code": "74246", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1179.69, "discounted_cash": 342.0, "minimum": 342.1101, "maximum": 1069.9788, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 350.13 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 429.03 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 343.22 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 429.03 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 429.03 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 820.53 } ] } ] }, { "description": "HC ASSAY OF IRON", "code_information": [ { "code": "83540", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 96.88, "discounted_cash": 28.0, "minimum": 6.47, "maximum": 87.8702, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 55.49, "10th_percentile": 55.49, "90th_percentile": 59.52, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 27.9, "10th_percentile": 27.9, "90th_percentile": 27.9, "count": "21" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 65.53 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 26.88, "10th_percentile": 26.88, "90th_percentile": 26.88, "count": "17" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 52.42 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 65.53 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 65.53 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 49.37, "10th_percentile": 49.37, "90th_percentile": 49.37, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 62.09, "10th_percentile": 60.92, "90th_percentile": 62.09, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 59.98 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 77.5, "10th_percentile": 14.19, "90th_percentile": 77.5, "count": "21" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 18.01, "10th_percentile": 18.01, "90th_percentile": 18.01, "count": "1 through 10" }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 77.5, "10th_percentile": 77.5, "90th_percentile": 77.5, "count": "123" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 24.8, "10th_percentile": 22.48, "90th_percentile": 24.8, "count": "83" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 70.29, "10th_percentile": 61.95, "90th_percentile": 70.99, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 24.8, "10th_percentile": 24.8, "90th_percentile": 28.68, "count": "57" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 24.8, "10th_percentile": 24.8, "90th_percentile": 24.8, "count": "20" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 24.8, "10th_percentile": 24.8, "90th_percentile": 26.35, "count": "36" } ] } ] }, { "description": "HC NASOPHARYNGOSCOPY WITH ENDOSCOPE", "code_information": [ { "code": "92511", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 248.13, "discounted_cash": 71.0, "minimum": 71.9577, "maximum": 225.0539, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "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": 943.0, "minimum": 257.45, "maximum": 2951.4324, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 679.05 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 832.07 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 665.66 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 832.07 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 832.07 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 1564.47, "10th_percentile": 1564.47, "90th_percentile": 1564.47, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2386.69 }, { "payer_name": "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1334.0, "10th_percentile": 1334.0, "90th_percentile": 2603.25, "count": "1 through 10" } ] } ] }, { "description": "Infliximab For IV Inj 100 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "57894003001", "type": "NDC" }, { "code": "J1745", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 96.138, "maximum": 1233.18, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1233.18 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 143.38 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 114.7 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 143.38 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 143.38 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 96.14 } ] } ] }, { "description": "HC GAIT TRAIN THERAPY COMPLEX, EA 15 MIN", "code_information": [ { "code": "97116", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 147.5, "discounted_cash": 42.0, "minimum": 27.85, "maximum": 133.7825, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 84.96, "10th_percentile": 84.96, "90th_percentile": 84.96, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 27.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 37.76, "10th_percentile": 24.07, "90th_percentile": 80.32, "count": "12" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 37.76, "10th_percentile": 37.76, "90th_percentile": 37.76, "count": "1 through 10" } ] } ] }, { "description": "CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC", "code_information": [ { "code": "261", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6276.0, "minimum": 6276.87, "maximum": 22287.07, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22287.07 } ] } ] }, { "description": "HC RO SET RADN THERAPY FIELD INTERME", "code_information": [ { "code": "77285", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1691.56, "discounted_cash": 490.0, "minimum": 490.5524, "maximum": 1534.2449, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1070.77 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1312.06 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1049.64 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1312.06 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1312.06 } ] } ] }, { "description": "BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC", "code_information": [ { "code": "519", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7173.0, "minimum": 7173.57, "maximum": 23580.32, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23580.32 } ] } ] }, { "description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC", "code_information": [ { "code": "432", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10984.0, "minimum": 10984.53, "maximum": 23203.07, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23203.07 } ] } ] }, { "description": "HC MRI BRAIN CONTRAST", "code_information": [ { "code": "70552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2251.88, "discounted_cash": 653.0, "minimum": 653.0452, "maximum": 2118.32, "payers_information": [ { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2118.32 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1646.73 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2118.32 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1694.64 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2118.32 } ] } ] }, { "description": "HC COMPATIBILITY TEST,SPIN TECH", "code_information": [ { "code": "86920", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 105.63, "discounted_cash": 30.0, "minimum": 30.6327, "maximum": 105.63, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 105.63 } ] } ] }, { "description": "HC (SUP SHELL L3660) SO 8 AB RSTR CAN/WEB PRE OTS", "code_information": [ { "code": "L3660", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 154.1, "maximum": 154.1, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 154.1, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY EXAM SELLA", "code_information": [ { "code": "70240", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 526.56, "discounted_cash": 152.0, "minimum": 75.77, "maximum": 477.5899, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 77.3 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 94.72 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 75.77 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 94.72 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 94.72 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 203.03 } ] } ] }, { "description": "SEPTIC ARTHRITIS WITHOUT CCMCC", "code_information": [ { "code": "550", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6949.0, "minimum": 6949.39, "maximum": 10304.75, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10304.75 } ] } ] }, { "description": "HC (SUP SHELL L2106) AFO TIB FX CAST PLASTER MOLD", "code_information": [ { "code": "L2106", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1041.75, "maximum": 1041.75, "payers_information": [ { "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" } ] } ] }, { "description": "PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC", "code_information": [ { "code": "040", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16140.0, "minimum": 16140.53, "maximum": 45519.61, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 45519.61 } ] } ] }, { "description": "HC QUANTITATIVE ASSAY, DRUG", "code_information": [ { "code": "80299", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 380.31, "discounted_cash": 110.0, "minimum": 18.64, "maximum": 344.9412, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 113.01 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 138.47 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 110.78 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 138.47 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 138.47 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 172.8 }, { "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 282.25, "10th_percentile": 221.5, "90th_percentile": 299.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 85.43, "10th_percentile": 50.64, "90th_percentile": 140.16, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 211.2, "10th_percentile": 211.2, "90th_percentile": 211.2, "count": "1 through 10" } ] } ] }, { "description": "HC VASOPNEUMATIC DEVICE THERAPY", "code_information": [ { "code": "97016", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 139.06, "discounted_cash": 40.0, "minimum": 11.44, "maximum": 126.1274, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "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" } ] } ] }, { "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": 46.0, "minimum": 46.4899, "maximum": 145.4012, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 41.04, "10th_percentile": 41.04, "90th_percentile": 41.04, "count": "1 through 10" } ] } ] }, { "description": "Magnesium Sulfate Inj 50%", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "63323006401", "type": "NDC" }, { "code": "J3475", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.5435, "maximum": 7.51, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 124.7, "10th_percentile": 124.7, "90th_percentile": 124.7, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7.51 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2.3 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.84 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 2.3 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 2.3 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.54 } ] } ] }, { "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": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC WHIRLPOOL THERAPY", "code_information": [ { "code": "97022", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 153.44, "discounted_cash": 44.0, "minimum": 14.8, "maximum": 139.1701, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "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" } ] } ] }, { "description": "HC ASSAY OF LDH ISOENZYMES", "code_information": [ { "code": "83625", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 231.25, "discounted_cash": 67.0, "minimum": 12.79, "maximum": 209.7438, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 105.66 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 129.47 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 103.57 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 129.47 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 129.47 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 118.57 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.79, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Fluphenazine Decanoate Inj 25 MG/ML", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "42023012901", "type": "NDC" }, { "code": "J2680", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 27.8145, "maximum": 204.88, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 204.88 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 41.48 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 33.18 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 41.48 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 41.48 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.81 } ] } ] }, { "description": "HC NASAL SMEAR FOR EOSINOPHILS", "code_information": [ { "code": "89190", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 121.88, "discounted_cash": 35.0, "minimum": 5.79, "maximum": 110.5452, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 39.18 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 48.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 38.4 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 48.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 48.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 53.68 }, { "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" } ] } ] }, { "description": "LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH CC", "code_information": [ { "code": "821", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7397.0, "minimum": 7397.74, "maximum": 26390.81, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26390.81 } ] } ] }, { "description": "OSTEOMYELITIS WITH CC", "code_information": [ { "code": "540", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9639.0, "minimum": 9639.48, "maximum": 15282.05, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "other", "standard_charge_dollar": 10073.27, "standard_charge_algorithm": "2342.62 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 3994.07, "10th_percentile": 3994.07, "90th_percentile": 3994.07, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15282.05 } ] } ] }, { "description": "HC (SUP SHELL A4617) MOUTH PIECE", "code_information": [ { "code": "A4617", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 4.42, "maximum": 4.42, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.42, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL A4315) CATH W/DRAINAGE 2-WAY SILCNE", "code_information": [ { "code": "A4315", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 31.95, "maximum": 31.95, "payers_information": [ { "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" } ] } ] }, { "description": "HC ASSAY OF RENIN", "code_information": [ { "code": "84244", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 322.81, "discounted_cash": 93.0, "minimum": 21.99, "maximum": 292.7887, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 181.58 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 222.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 178.0 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 222.5 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 222.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 203.86 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 258.25, "10th_percentile": 258.25, "90th_percentile": 258.25, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 258.25, "10th_percentile": 258.25, "90th_percentile": 258.25, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 82.64, "10th_percentile": 82.64, "90th_percentile": 82.64, "count": "1 through 10" } ] } ] }, { "description": "HC CHEST X-RAY 1 VW", "code_information": [ { "code": "71045", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 319.06, "discounted_cash": 92.0, "minimum": 42.82, "maximum": 289.3874, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 182.76, "10th_percentile": 182.76, "90th_percentile": 182.76, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 43.68 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 53.53 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 42.82 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 53.53 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 53.53 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 146.62 } ] } ] }, { "description": "HC (SUP SHELL L0172) CERV COL SR FOAM 2PC PRE OTS", "code_information": [ { "code": "L0172", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 145.89, "maximum": 145.89, "payers_information": [ { "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" } ] } ] }, { "description": "Prednisone Tab 1 MG", "drug_information": { "unit": 100.0, "type": "EA" }, "code_information": [ { "code": "00603533521", "type": "NDC" }, { "code": "J7512", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "HC TRANSFERASE ASPARTATE AMINO (AST) (SGOT)", "code_information": [ { "code": "84450", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 66.88, "discounted_cash": 19.0, "minimum": 5.18, "maximum": 60.6602, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 38.31, "10th_percentile": 38.31, "90th_percentile": 41.46, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 19.26, "10th_percentile": 19.26, "90th_percentile": 19.26, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 42.68 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 52.3 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 18.55, "10th_percentile": 18.55, "90th_percentile": 18.55, "count": "13" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 41.84 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 52.3 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 52.3 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 34.08, "10th_percentile": 34.08, "90th_percentile": 34.08, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 42.05, "10th_percentile": 42.05, "90th_percentile": 42.05, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 48.02 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 51.76, "10th_percentile": 20.71, "90th_percentile": 53.5, "count": "1 through 10" }, { "payer_name": "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 53.5, "10th_percentile": 53.5, "90th_percentile": 53.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 17.12, "10th_percentile": 17.12, "90th_percentile": 17.12, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 17.12, "10th_percentile": 17.12, "90th_percentile": 19.8, "count": "26" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 17.12, "10th_percentile": 17.12, "90th_percentile": 18.19, "count": "1 through 10" } ] } ] }, { "description": "HC NM HEPATOBILIARY SYST IMAGING INCLUDING GALLBLADDR", "code_information": [ { "code": "78226", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1631.25, "discounted_cash": 473.0, "minimum": 473.0625, "maximum": 1631.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1186.77 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1454.21 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1163.36 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1454.21 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1454.21 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1631.25 } ] } ] }, { "description": "HC ASSAY OF PHENYTOIN, TOTAL", "code_information": [ { "code": "80185", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 199.69, "discounted_cash": 57.0, "minimum": 13.25, "maximum": 181.1188, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 109.44 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 134.11 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 52.29, "10th_percentile": 52.29, "90th_percentile": 52.29, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 107.29 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 134.11 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 134.11 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 122.83 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 98.31, "10th_percentile": 98.31, "90th_percentile": 98.31, "count": "1 through 10" }, { "payer_name": "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 Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 48.24, "10th_percentile": 48.24, "90th_percentile": 48.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 51.12, "10th_percentile": 51.12, "90th_percentile": 51.12, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL L3960) SEWHO AIRPLAN DESIG ABDU POS", "code_information": [ { "code": "L3960", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 981.86, "maximum": 981.86, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 981.86, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF HISTAMINE", "code_information": [ { "code": "83088", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 126.88, "discounted_cash": 36.0, "minimum": 29.53, "maximum": 126.88, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 126.88 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 126.88 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 126.88 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 126.88 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 126.88 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 29.53, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "544", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6052.0, "minimum": 6052.7, "maximum": 12769.713, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8895.96 } ] } ] }, { "description": "HC (SUP SHELL Q4155) NEOXFLO OR CLARIXFLO 1 MG", "code_information": [ { "code": "Q4155", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 82.8765, "maximum": 123.6, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 123.6 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 98.88 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 123.6 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 123.6 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 82.88 } ] } ] }, { "description": "HC TEST FOR CHLOROHYDROCARBONS", "code_information": [ { "code": "82441", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 264.06, "discounted_cash": 76.0, "minimum": 6.01, "maximum": 239.5024, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 49.52 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 60.68 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 48.54 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 60.68 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 60.68 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 55.72 }, { "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" } ] } ] }, { "description": "HC (SUP SHELL A4412) OST POUCH DRAIN HIGH OUTPUT", "code_information": [ { "code": "A4412", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 3.86, "maximum": 3.86, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3.86, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITH MCC", "code_information": [ { "code": "695", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8070.0, "minimum": 8070.26, "maximum": 13484.24, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13484.24 } ] } ] }, { "description": "HC B CELLS, TOTAL COUNT", "code_information": [ { "code": "86355", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 238.75, "discounted_cash": 69.0, "minimum": 37.73, "maximum": 238.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 94.58 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 115.89 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 92.71 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 115.89 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 115.89 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 150.13, "10th_percentile": 150.13, "90th_percentile": 150.13, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 238.75 }, { "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" } ] } ] }, { "description": "HC THYROID MET IMAGING BODY", "code_information": [ { "code": "78018", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2139.69, "discounted_cash": 620.0, "minimum": 620.5101, "maximum": 2080.9938, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1072.26 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1313.89 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1051.11 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1313.89 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1313.89 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2080.99 } ] } ] }, { "description": "HC (SUP SHELL A4619) FACE TENT", "code_information": [ { "code": "A4619", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2.57, "maximum": 2.57, "payers_information": [ { "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" } ] } ] }, { "description": "HC NM BRAIN IMAGING MIN 4 STATIC VIEWS", "code_information": [ { "code": "78605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1752.19, "discounted_cash": 508.0, "minimum": 508.1351, "maximum": 1589.2363, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 656.49 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 804.42 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 643.54 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 804.42 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 804.42 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1361.95 } ] } ] }, { "description": "PERITONEAL ADHESIOLYSIS WITH CC", "code_information": [ { "code": "336", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11432.0, "minimum": 11432.87, "maximum": 24859.42, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24859.42 } ] } ] }, { "description": "HC (SUP SHELL A6451) MOD COMPRES BAND W>=3<5/YD", "code_information": [ { "code": "A6451", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2.5, "maximum": 2.5, "payers_information": [ { "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" } ] } ] }, { "description": "HC (SUP SHELL Q4150) ALLOWRAP DS OR DRY 1 SQ CM", "code_information": [ { "code": "Q4150", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 260.694, "maximum": 388.79, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 388.79 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 311.03 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 388.79 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 388.79 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 260.69 } ] } ] }, { "description": "SEIZURES WITH MCC", "code_information": [ { "code": "100", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9639.0, "minimum": 9639.48, "maximum": 22832.9, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22832.9 } ] } ] }, { "description": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH CC", "code_information": [ { "code": "835", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9863.0, "minimum": 9863.66, "maximum": 24589.45, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24589.45 } ] } ] }, { "description": "MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITHOUT CCMCC", "code_information": [ { "code": "437", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5380.0, "minimum": 5380.18, "maximum": 10059.54, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10059.54 } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CCMCC", "code_information": [ { "code": "285", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 2465.0, "minimum": 2465.91, "maximum": 7060.42, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7060.42 } ] } ] }, { "description": "DISORDERS OF PERSONALITY AND IMPULSE CONTROL", "code_information": [ { "code": "883", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13002.0, "minimum": 13002.09, "maximum": 23180.67, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23180.67 } ] } ] }, { "description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC", "code_information": [ { "code": "308", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7621.0, "minimum": 7621.92, "maximum": 36767.187, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 7621.92, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 12862.92, "10th_percentile": 12862.92, "90th_percentile": 12862.92, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "other", "standard_charge_dollar": 7621.92, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 14760.0, "10th_percentile": 14760.0, "90th_percentile": 17220.0, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14193.93 } ] } ] }, { "description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CCMCC", "code_information": [ { "code": "479", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7397.0, "minimum": 7397.74, "maximum": 21914.53, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21914.53 } ] } ] }, { "description": "HC (SUP SHELL L0140) CERVICAL SEMI-RIGID ADJUSTAB", "code_information": [ { "code": "L0140", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 95.1, "maximum": 95.1, "payers_information": [ { "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" } ] } ] }, { "description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC", "code_information": [ { "code": "847", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8518.0, "minimum": 8518.61, "maximum": 15422.34, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15422.34 } ] } ] }, { "description": "HC ANGIO AORTOBIFEMORAL W CATH", "code_information": [ { "code": "75630", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10255.9, "discounted_cash": 2974.0, "minimum": 547.0189, "maximum": 9302.1013, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 901.57 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1104.73 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 883.78 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1104.73 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1104.73 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 547.02 } ] } ] }, { "description": "HC (SUP SHELL A4385) OST SKN BARRIER SLD EXT WEAR", "code_information": [ { "code": "A4385", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 7.26, "maximum": 7.26, "payers_information": [ { "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" } ] } ] }, { "description": "ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC", "code_information": [ { "code": "392", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5604.0, "minimum": 5604.35, "maximum": 12694.8522, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "other", "standard_charge_dollar": 5604.35, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 4480.0, "10th_percentile": 4480.0, "90th_percentile": 12300.0, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9190.69 } ] } ] }, { "description": "KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC", "code_information": [ { "code": "650", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14122.0, "minimum": 14122.96, "maximum": 55424.71, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 55424.71 } ] } ] }, { "description": "HC (SUP SHELL A4425) OST PCH DRAIN FOR BARRIER FL", "code_information": [ { "code": "A4425", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 5.1, "maximum": 12.64, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.64 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 10.11 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 12.64 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 12.64 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.1, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Tenecteplase For IV Soln Kit 50 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "50242017601", "type": "NDC" }, { "code": "J3101", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 511.749, "maximum": 1778.88, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1778.88 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 763.2 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 610.56 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 763.2 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 763.2 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 511.75 } ] } ] }, { "description": "HC ASSTV TECHNOL ASSMT DIR CNTCT W/REPRT EA 15 MIN", "code_information": [ { "code": "97755", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 226.88, "discounted_cash": 65.0, "minimum": 36.28, "maximum": 205.7802, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 36.28, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC X-RAY SMALL BOWEL ENTEROCLYSIS", "code_information": [ { "code": "74251", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1381.25, "discounted_cash": 400.0, "minimum": 400.5625, "maximum": 1381.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 577.69 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 707.87 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 566.3 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 707.87 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 707.87 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1381.25 } ] } ] }, { "description": "HC (SUP SHELL L3913) HFO W/O JOINTS CF", "code_information": [ { "code": "L3913", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 295.66, "maximum": 295.66, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 295.66, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC BLOOD GASES: PH, PO2 & PCO2", "code_information": [ { "code": "82803", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 372.81, "discounted_cash": 108.0, "minimum": 26.07, "maximum": 338.1387, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 159.7 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 195.69 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 156.55 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 195.69 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 195.69 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 241.68 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC BARTONELLA DNA AMP PROBE", "code_information": [ { "code": "87471", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1521.56, "discounted_cash": 441.0, "minimum": 35.09, "maximum": 1380.0549, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 214.99 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 263.43 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 210.75 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 263.43 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 263.43 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 325.3 }, { "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" } ] } ] }, { "description": "HC ASSAY OF AMITRIPTYLINE - G0480 - 30100408", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 221.25, "minimum": 33.0774, "maximum": 1060.8233, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 221.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 221.25 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 221.25 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 221.25 }, { "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": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 173.49, "10th_percentile": 173.49, "90th_percentile": 173.49, "count": "1 through 10" }, { "payer_name": "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 432.75, "10th_percentile": 164.25, "90th_percentile": 1052.5, "count": "14" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 95.76, "10th_percentile": 95.76, "90th_percentile": 95.76, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 363.48, "10th_percentile": 363.48, "90th_percentile": 375.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 132.48, "10th_percentile": 132.48, "90th_percentile": 257.04, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 132.77, "10th_percentile": 132.77, "90th_percentile": 337.54, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 55.85, "10th_percentile": 55.85, "90th_percentile": 55.85, "count": "1 through 10" } ] } ] }, { "description": "OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH CC", "code_information": [ { "code": "424", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10087.0, "minimum": 10087.83, "maximum": 25793.11, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25793.11 } ] } ] }, { "description": "HC IADNA MYCOPLASMA GENITALIUM AMPLIFIED PROBE TECH", "code_information": [ { "code": "87563", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 594.06, "discounted_cash": 172.0, "minimum": 35.09, "maximum": 538.8124, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 325.3 }, { "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" } ] } ] }, { "description": "HC (SUP SHELL A4407) EXT WEAR OST SKN BARR <=4SQ", "code_information": [ { "code": "A4407", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 12.48, "maximum": 37.44, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 37.44 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 29.95 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 37.44 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 37.44 }, { "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" } ] } ] }, { "description": "HC (SUP SHELL L8002) BRST PRSTH BRA & BILAT FORM", "code_information": [ { "code": "L8002", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 198.27, "maximum": 198.27, "payers_information": [ { "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" } ] } ] }, { "description": "HC ASSAY UREA NITROGEN, QUAN", "code_information": [ { "code": "84520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 72.81, "discounted_cash": 21.0, "minimum": 3.95, "maximum": 66.0387, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 44.74, "10th_percentile": 44.74, "90th_percentile": 44.74, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 20.97, "10th_percentile": 20.97, "90th_percentile": 20.97, "count": "15" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 32.56 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 39.9 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 20.21, "10th_percentile": 20.21, "90th_percentile": 20.21, "count": "11" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 31.92 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 39.9 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 39.9 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.62 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 29.28, "10th_percentile": 12.88, "90th_percentile": 58.25, "count": "12" }, { "payer_name": "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 58.25, "10th_percentile": 58.25, "90th_percentile": 58.25, "count": "20" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 18.64, "10th_percentile": 3.95, "90th_percentile": 19.81, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 52.83, "10th_percentile": 52.83, "90th_percentile": 52.83, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 18.64, "10th_percentile": 18.64, "90th_percentile": 21.55, "count": "13" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 18.64, "10th_percentile": 18.64, "90th_percentile": 19.81, "count": "21" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 18.64, "10th_percentile": 18.64, "90th_percentile": 19.81, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL A5073) URINARY POUCH ON BARR W/FLNG", "code_information": [ { "code": "A5073", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 4.53, "maximum": 4.53, "payers_information": [ { "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" } ] } ] }, { "description": "HC (SUP SHELL Q4170) CYGNUS, PER SQ CM", "code_information": [ { "code": "Q4170", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1400.931, "maximum": 4552.17, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4552.17 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 3641.7 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 4552.17 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 4552.17 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1400.93 } ] } ] }, { "description": "HC NM BRAIN IMAGING < 4 STATIC VIEWS", "code_information": [ { "code": "78600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1752.19, "discounted_cash": 508.0, "minimum": 508.1351, "maximum": 1589.2363, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 596.66 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 731.12 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 584.89 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 731.12 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 731.12 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1252.0 } ] } ] }, { "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": "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" } ] } ] }, { "description": "HC (SUP SHELL A4364) ADHESIVE, LIQUID OR EQUAL", "code_information": [ { "code": "A4364", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 4.19, "maximum": 4.19, "payers_information": [ { "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" } ] } ] }, { "description": "HC ASSAY OF THEOPHYLLINE", "code_information": [ { "code": "80198", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 192.81, "discounted_cash": 55.0, "minimum": 14.14, "maximum": 174.8787, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 116.79 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 143.11 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 114.49 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 143.11 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 143.11 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 131.08 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL Q4175) MIRODERM", "code_information": [ { "code": "Q4175", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 215.964, "maximum": 968.3, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 968.3 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 322.08 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 257.66 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 322.08 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 322.08 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 215.96 } ] } ] }, { "description": "Tbo-Filgrastim Soln Prefilled Syringe 480 MCG/0.8ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "63459091211", "type": "NDC" }, { "code": "J1447", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.1655, "maximum": 8.66, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.66 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.74 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1.39 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.74 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1.74 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.17 } ] } ] }, { "description": "PANCREAS TRANSPLANT", "code_information": [ { "code": "010", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13226.0, "minimum": 13226.27, "maximum": 84594.18, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 84594.18 } ] } ] }, { "description": "HC (SUP SHELL A4615) CANNULA NASAL - A4615 - RU272033", "code_information": [ { "code": "A4615", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.04, "maximum": 1.04, "payers_information": [ { "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" } ] } ] }, { "description": "HC (SUP SHELL L0200) CERV COL SUPP ADJ BAR & THOR", "code_information": [ { "code": "L0200", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 645.2, "maximum": 645.2, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 645.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC VENOGRAM SINUS/JUGULAR", "code_information": [ { "code": "75860", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2597.5, "discounted_cash": 753.0, "minimum": 617.5646, "maximum": 2355.9325, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 859.26 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1052.89 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 842.31 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1052.89 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1052.89 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 617.56 } ] } ] }, { "description": "HC NEG PRESS WOUND TX W DME, 96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES", "code_information": [ { "code": "004", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 50214.0, "minimum": 50214.98, "maximum": 163293.88, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 163293.88 } ] } ] }, { "description": "Infliximab-abda For IV Inj 100 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "78206016201", "type": "NDC" }, { "code": "Q5104", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 87.7275, "maximum": 1017.41, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1017.41 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 130.79 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 104.63 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 130.79 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 130.79 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 87.73 } ] } ] }, { "description": "MASTECTOMY FOR MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "583", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3810.0, "minimum": 3810.96, "maximum": 20328.92, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20328.92 } ] } ] }, { "description": "Cyanocobalamin Inj 1000 MCG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "63323004400", "type": "NDC" }, { "code": "J3420", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2.1105, "maximum": 28.06, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 28.06 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.15 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 2.52 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 3.15 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 3.15 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2.11 } ] } ] }, { "description": "HC (SUP SHELL A4424) OST PCH DRAIN W BAR & FILTER - A4424 - 27200086", "code_information": [ { "code": "A4424", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 6.78, "maximum": 6.78, "payers_information": [ { "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" } ] } ] }, { "description": "ALLERGIC REACTIONS WITHOUT MCC", "code_information": [ { "code": "916", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4035.0, "minimum": 4035.13, "maximum": 7855.0, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7855.0 } ] } ] }, { "description": "PNEUMOTHORAX WITH CC", "code_information": [ { "code": "200", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6949.0, "minimum": 6949.39, "maximum": 12959.63, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12959.63 } ] } ] }, { "description": "VEIN LIGATION AND STRIPPING", "code_information": [ { "code": "263", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10536.0, "minimum": 10536.18, "maximum": 36043.63, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 36043.63 } ] } ] }, { "description": "HC DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX C-/C+", "code_information": [ { "code": "71270", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3931.56, "discounted_cash": 1140.0, "minimum": 650.0, "maximum": 3565.9249, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1691.07 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1352.85 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1691.07 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1691.07 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1209.66 } ] } ] }, { "description": "TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC", "code_information": [ { "code": "604", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8742.0, "minimum": 8742.79, "maximum": 17354.56, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17354.56 } ] } ] }, { "description": "HC X-RAY FOREARM 2 VW", "code_information": [ { "code": "73090", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 439.38, "discounted_cash": 127.0, "minimum": 74.35, "maximum": 398.5177, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 269.95, "10th_percentile": 256.91, "90th_percentile": 272.41, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 126.54, "10th_percentile": 126.54, "90th_percentile": 126.54, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 75.84 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 92.93 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 74.35 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 92.93 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 92.93 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 281.55, "10th_percentile": 281.55, "90th_percentile": 281.55, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 183.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 351.5, "10th_percentile": 331.5, "90th_percentile": 351.5, "count": "29" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 112.48, "10th_percentile": 112.48, "90th_percentile": 112.48, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 106.08, "10th_percentile": 106.08, "90th_percentile": 106.08, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 112.48, "10th_percentile": 112.48, "90th_percentile": 112.48, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL L4386) NON-PNEUM WALK BOOT PRE CST", "code_information": [ { "code": "L4386", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 190.16, "maximum": 190.16, "payers_information": [ { "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" } ] } ] }, { "description": "CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC", "code_information": [ { "code": "236", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13002.0, "minimum": 13002.09, "maximum": 49381.68, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 49381.68 } ] } ] }, { "description": "HC X-RAY THORACIC SPINE 2 VW", "code_information": [ { "code": "72070", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 608.44, "discounted_cash": 176.0, "minimum": 88.66, "maximum": 551.8551, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 373.82, "10th_percentile": 373.82, "90th_percentile": 373.82, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 165.33, "10th_percentile": 165.33, "90th_percentile": 175.23, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 90.44 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 110.83 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 159.27, "10th_percentile": 159.27, "90th_percentile": 159.27, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 88.66 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 110.83 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 110.83 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 292.54, "10th_percentile": 292.54, "90th_percentile": 292.54, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 197.36 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 155.76, "10th_percentile": 155.76, "90th_percentile": 155.76, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 459.25, "10th_percentile": 459.25, "90th_percentile": 486.75, "count": "14" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 155.76, "10th_percentile": 146.96, "90th_percentile": 155.76, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 441.48, "10th_percentile": 420.67, "90th_percentile": 441.48, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 155.76, "10th_percentile": 155.76, "90th_percentile": 169.92, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 146.96, "10th_percentile": 146.96, "90th_percentile": 156.15, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL A4455) ADHESIVE REMOVER PER OUNCE", "code_information": [ { "code": "A4455", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 2.03, "maximum": 30.54, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 30.54 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 24.43 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 30.54 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 30.54 }, { "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" } ] } ] }, { "description": "HC DUPLEX EXTREM VENOUS,UNI OR LTD", "code_information": [ { "code": "93971", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1617.19, "discounted_cash": 468.0, "minimum": 468.9851, "maximum": 1466.7913, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 752.34, "10th_percentile": 752.34, "90th_percentile": 752.34, "count": "1 through 10" } ] } ] }, { "description": "HC X-RAY OPER CHOLANGIO ADDNL SET", "code_information": [ { "code": "74301", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1532.19, "discounted_cash": 444.0, "minimum": 80.1, "maximum": 1389.6963, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 81.71 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 100.12 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 80.1 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 100.12 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 100.12 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 152.29 } ] } ] }, { "description": "SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC", "code_information": [ { "code": "577", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9639.0, "minimum": 9639.48, "maximum": 31249.05, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 31249.05 } ] } ] }, { "description": "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": 5.0715, "maximum": 7.56, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.56 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 6.05 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 7.56 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 7.56 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.07 } ] } ] }, { "description": "EXTRACRANIAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "039", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 2690.0, "minimum": 2690.09, "maximum": 13857.95, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13857.95 } ] } ] }, { "description": "SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC", "code_information": [ { "code": "871", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10760.0, "minimum": 10760.35, "maximum": 22900.09, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "other", "standard_charge_dollar": 11244.58, "standard_charge_algorithm": "2342.62 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 8859.86, "10th_percentile": 8859.86, "90th_percentile": 8859.86, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 10760.35, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 2143.82, "10th_percentile": 2143.82, "90th_percentile": 24670.44, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22900.09 } ] } ] }, { "description": "HC PLATELET COUNT", "code_information": [ { "code": "85049", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 76.25, "discounted_cash": 22.0, "minimum": 4.48, "maximum": 69.1587, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 36.91 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 45.23 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 21.15, "10th_percentile": 21.15, "90th_percentile": 21.15, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 36.19 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 45.23 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 45.23 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.53 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 57.5, "10th_percentile": 57.5, "90th_percentile": 61.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 18.4, "10th_percentile": 4.48, "90th_percentile": 19.55, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 19.52, "10th_percentile": 19.52, "90th_percentile": 19.52, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 19.52, "10th_percentile": 19.52, "90th_percentile": 19.52, "count": "1 through 10" } ] } ] }, { "description": "HC (SUP SHELL A6402) STERILE GAUZE <= 16 SQ IN - A6402 - 27200152", "code_information": [ { "code": "A6402", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 1.0, "payers_information": [ { "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" } ] } ] }, { "description": "Dobutamine in Dextrose 5% Inj 1 MG/ML", "drug_information": { "unit": 250.0, "type": "ML" }, "code_information": [ { "code": "00338107302", "type": "NDC" }, { "code": "J1250", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 25.6725, "maximum": 74.38, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 74.38 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 38.24 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 30.59 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 38.24 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 38.24 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.67 } ] } ] }, { "description": "FULL TERM NEONATE WITH MAJOR PROBLEMS", "code_information": [ { "code": "793", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10536.0, "minimum": 10536.18, "maximum": 49155.33, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 49155.33 } ] } ] }, { "description": "HC ASSAY, SERUM CHOLINESTERASE", "code_information": [ { "code": "82480", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 243.44, "discounted_cash": 70.0, "minimum": 7.87, "maximum": 220.8001, "payers_information": [ { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 79.73 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 72.96 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 65.07 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 79.73 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 63.78 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 79.73 } ] } ] }, { "description": "Prothrombin Complex Conc Human For Inj Kit 500 Unit", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "63833038602", "type": "NDC" }, { "code": "J7168", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 9.576, "maximum": 14.28, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.28 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 11.42 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 14.28 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 14.28 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.58 } ] } ] }, { "description": "HC PLATELET ANTIBODIES", "code_information": [ { "code": "86022", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1070.0, "discounted_cash": 310.0, "minimum": 18.37, "maximum": 970.49, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 151.62 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 185.78 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 148.63 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 185.78 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 185.78 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 170.3 }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18.37, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC", "code_information": [ { "code": "372", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8070.0, "minimum": 8070.26, "maximum": 19986.8549, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 8070.26, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 27298.88, "10th_percentile": 27298.88, "90th_percentile": 27298.88, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "other", "standard_charge_dollar": 8070.26, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 9840.0, "10th_percentile": 9840.0, "90th_percentile": 9840.0, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12036.55 } ] } ] }, { "description": "POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "856", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20399.0, "minimum": 20399.83, "maximum": 53624.53, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 53624.53 } ] } ] }, { "description": "MAJOR CHEST PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "165", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4483.0, "minimum": 4483.48, "maximum": 22566.47, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22566.47 } ] } ] }, { "description": "DEPRESSIVE NEUROSES", "code_information": [ { "code": "881", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9191.0, "minimum": 9191.13, "maximum": 11092.25, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11092.25 } ] } ] }, { "description": "HC BETA-2 PROTEIN", "code_information": [ { "code": "82232", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 267.19, "discounted_cash": 77.0, "minimum": 16.18, "maximum": 242.3413, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 133.53 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 163.62 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 130.89 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 163.62 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 163.62 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 150.0 }, { "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": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 68.4, "10th_percentile": 68.4, "90th_percentile": 68.4, "count": "1 through 10" } ] } ] }, { "description": "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": 148.0, "minimum": 148.1726, "maximum": 510.94, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 309.28 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 247.42 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 309.28 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 309.28 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 510.94 } ] } ] }, { "description": "OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC", "code_information": [ { "code": "205", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9863.0, "minimum": 9515.6913, "maximum": 21585.62, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 9863.66, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 9749.6, "10th_percentile": 9749.6, "90th_percentile": 9749.6, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21585.62 } ] } ] }, { "description": "HC ASSAY OF FERRITIN", "code_information": [ { "code": "82728", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 210.63, "discounted_cash": 61.0, "minimum": 13.63, "maximum": 191.0414, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 120.65, "10th_percentile": 120.65, "90th_percentile": 129.41, "count": "13" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 60.66, "10th_percentile": 60.66, "90th_percentile": 60.66, "count": "25" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 112.44 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 137.78 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 58.44, "10th_percentile": 58.44, "90th_percentile": 58.44, "count": "32" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 110.22 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 137.78 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 137.78 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 107.33, "10th_percentile": 107.33, "90th_percentile": 107.33, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 132.44, "10th_percentile": 132.44, "90th_percentile": 134.99, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 126.36 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 111.62, "10th_percentile": 57.29, "90th_percentile": 168.5, "count": "23" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 39.17, "10th_percentile": 39.17, "90th_percentile": 39.17, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 168.5, "10th_percentile": 168.5, "90th_percentile": 168.5, "count": "148" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 53.92, "10th_percentile": 48.87, "90th_percentile": 57.29, "count": "94" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 152.83, "10th_percentile": 134.68, "90th_percentile": 154.35, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 53.92, "10th_percentile": 53.92, "90th_percentile": 62.35, "count": "74" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 53.92, "10th_percentile": 53.92, "90th_percentile": 57.29, "count": "21" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 53.92, "10th_percentile": 53.92, "90th_percentile": 57.29, "count": "36" } ] } ] }, { "description": "HC BLOOD FOLIC ACID SERUM", "code_information": [ { "code": "82746", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 183.13, "discounted_cash": 53.0, "minimum": 14.7, "maximum": 166.0989, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 104.89, "10th_percentile": 104.89, "90th_percentile": 104.89, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 52.74, "10th_percentile": 52.74, "90th_percentile": 52.74, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 121.37 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 148.72 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 50.81, "10th_percentile": 50.81, "90th_percentile": 50.81, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 118.98 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 148.72 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 148.72 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 93.32, "10th_percentile": 93.32, "90th_percentile": 93.32, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 115.15, "10th_percentile": 115.15, "90th_percentile": 117.36, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 136.28 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 34.05, "10th_percentile": 34.05, "90th_percentile": 34.05, "count": "1 through 10" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 146.5, "10th_percentile": 146.5, "90th_percentile": 146.5, "count": "62" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 46.88, "10th_percentile": 46.88, "90th_percentile": 46.88, "count": "24" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 132.88, "10th_percentile": 117.1, "90th_percentile": 132.88, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 46.88, "10th_percentile": 46.88, "90th_percentile": 46.88, "count": "29" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 49.81, "10th_percentile": 46.88, "90th_percentile": 49.81, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 46.88, "10th_percentile": 46.88, "90th_percentile": 49.81, "count": "11" } ] } ] }, { "description": "KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC", "code_information": [ { "code": "660", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6276.0, "minimum": 6276.87, "maximum": 15581.49, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15581.49 } ] } ] }, { "description": "HC CSF FLUID SCAN CISTERNOGRAPHY", "code_information": [ { "code": "78630", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1283.75, "discounted_cash": 372.0, "minimum": 372.2875, "maximum": 1283.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1133.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1283.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Pathway Enhanced and Pathway X Enhanced", "methodology": "fee schedule", "standard_charge_dollar": 1111.14 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER with Cap", "methodology": "fee schedule", "standard_charge_dollar": 1283.75 }, { "payer_name": "Anthem Adhoc", "plan_name": "Anthem HMO POS PPO Adhoc No ER without Cap", "methodology": "fee schedule", "standard_charge_dollar": 1283.75 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1283.75 } ] } ] }, { "description": "CAROTID ARTERY STENT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "036", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 2690.0, "minimum": 2690.09, "maximum": 22903.63, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22903.63 } ] } ] }, { "description": "SPLENIC PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "801", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5380.0, "minimum": 5380.18, "maximum": 22503.98, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22503.98 } ] } ] }, { "description": "RECTAL RESECTION WITHOUT CCMCC", "code_information": [ { "code": "334", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4931.0, "minimum": 4931.83, "maximum": 19309.17, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19309.17 } ] } ] } ] }